Andell Pontus, Li Xinjun, Martinsson Andreas, Nilsson Peter M, Zöller Bengt, Smith J Gustav, Sundquist Kristina
Unit of Cardiology, Department of Medicine, Karolinska Institute, Heart and Vascular Division, Karolinska University Hospital, Stockholm, Sweden; Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden.
Center for Primary Health Care Research, Lund University, Malmö, Sweden.
Int J Cardiol. 2020 Nov 1;318:153-159. doi: 10.1016/j.ijcard.2020.06.034. Epub 2020 Jun 29.
Aortic stenosis (AS) is the most common valvular heart disease in developed countries, confers high mortality in advanced cases, but can effectively be reversed using endovascular or open-heart surgery. We evaluated the association between AS and neighborhood socioeconomic status (NSES).
We used Swedish population-based nationwide registers and an echocardiography screening cohort during the study period 1997-2014. NSES was determined by an established neighborhood deprivation index composed of education, income, unemployment, and receipt of social welfare. Multilevel adjusted logistic regression models determined the association between NSES and incident AS (according to ICD-10 diagnostic codes).
The study population of men and women (n=6,641,905) was divided into individuals living in high (n = 1,608,815 [24%]), moderate (n = 3,857,367 [58%]) and low (n = 1,175,723 [18%]) SES neighborhoods. There were 63,227 AS cases in total. Low NSES (versus high) was associated with a slightly increased risk of AS (OR 1.06 [95% CI 1.03-1.08]) in the nationwide study population. In the echocardiography screening cohort (n = 1586), the association between low NSES and AS was markedly stronger (OR: 2.73 [1.05-7.12]). There were more previously undiagnosed AS cases in low compared to high SES neighborhoods (3.1% versus 1.0%).
In this nationwide Swedish register study, low NSES was associated with a slightly increased risk of incident AS. However, the association was markedly stronger in the echocardiography screening cohort, which revealed an almost three-fold increase of AS among individuals living in low SES neighborhoods, possibly indicating an underdiagnosis of AS among these individuals.
在发达国家，主动脉瓣狭窄（AS）是最常见的心脏瓣膜病，在病情严重时死亡率很高，但可通过血管内手术或心脏直视手术有效逆转。我们评估了AS与社区社会经济地位（NSES）之间的关联。
我们使用了瑞典基于人群的全国登记册以及1997年至2014年研究期间的超声心动图筛查队列。NSES由一个既定的社区贫困指数确定，该指数由教育、收入失业和社会福利领取情况组成。多水平调整逻辑回归模型确定了NSES与新发AS（根据ICD-10诊断代码）之间的关联。
研究人群包括男性和女性（n = 6,641,905），分为生活在高社会经济地位社区（n = 1,608,815 [24%]）、中等社会经济地位社区（n = 3,857,367 [58%]）和低社会经济地位社区（n = 1,175,723 [18%]）的个体。共有63,227例AS病例。在全国研究人群中，低NSES（与高NSES相比）与AS风险略有增加相关（比值比1.06 [95%置信区间1.03 - 1.08]）。在超声心动图筛查队列（n = 1586）中，低NSES与AS之间的关联明显更强（比值比：）。与高社会经济地位社区相比，低社会经济地位社区中既往未诊断出的AS病例更多（3.1%对1.0%）。
在这项瑞典全国登记研究中，低NSES与新发AS风险略有增加相关。然而，在超声心动图筛查队列中这种关联明显更强，该队列显示生活在低社会经济地位社区的个体中AS增加了近三倍，这可能表明这些个体中AS存在诊断不足的情况。
