Impact of socioeconomic status on incident heart failure and left ventricular dysfunction: systematic review and meta-analysis

Aims Socioeconomic status (SES) is recognizably linked with incident heart failure (HF) risk and the association of SES with geography presents a potential target for geographical location of preventive health services. To better inform policy we sought to quantify the independent association between SES and incident HF and investigate differences by type of SES measure Methods and results MEDLINE and EMBASE were searched up to August 2018. Observational studies and randomized trials reporting adjusted HF incidence by stratified socioeconomic measures were included. Effect sizes reflected HF incidence in the lowest vs. highest SES stratum and were pooled using a random-effects model. Low SES referred to the lowest resource stratum, the definition of which varied across studies: meta-analysis was only performed where strata were comparable. Statistical heterogeneity was assessed using the I-2 statistic. Eleven studies comprising 6 308 006 individuals and 104 217 HF events found that low SES was associated with an increase in risk of incident HF ranging between 43% and 87% depending on SES measure, with an overall estimate of 62% [hazard ratio (HR) 1.62, 95% confidence interval (CI) 1.50-1.76]. By individual measure, HRs of 1.66 (95% CI 1.3-2.11), 1.87 (95% CI 1.33-2.62), and 1.54 (95% CI 1.22-1.95) were observed for education, income, and occupation, respectively. For area-level indexes, HRs were 1.43 (95% CI 1.2-1.69) (Carstairs index) and 1.61 (95% CI 1.56-1.65) (index of multiple deprivation) Conclusion Low SES assessed by all common measures confers independent risk for incident HF. These findings carry implications for the design and delivery of HF prevention programmes.