Socioeconomic Status, Gender, and Cardiovascular Disease

Study Questions:

Are there sex differences in the association of socioeconomic status (SES) and cardiovascular disease (CVD)?


This was a systematic review and meta-analysis, which used a PubMed MEDLINE search to identify studies that reported data on SES characteristics and CVD outcomes including coronary heart disease (CHD), stroke, or CVD by sex. The primary endpoints were combined fatal and nonfatal incident CHD, stroke, or CVD. The primary exposures (SES) included education, occupation, income, or area of residence.


A total of 5,300 articles were identified, of which 44 articles were included in this analysis. In total, 22 cohorts were from Asia, 75 from Europe, 7 from North America, and 12 from Australasia. Over 22 million adults (35% women) were included, of which 1,078,459 events were identified (701,617 CHD, 82,036 stroke, and 294,752 CVD). Lower SES appeared to be associated with increased risk of CHD, stroke, and CVD in women and men. Compared with men, women had greater risk for CHD associated with lower educational attainment. The pooled age-adjusted relative risk (RR) for CHD for the lowest versus highest level of education was 1.66 (95% confidence interval, 1.46-1.88) for women and 1.30 (1.15-1.48) for men. Women with the lowest level of education were at a 24% higher excess risk of CHD compared with men with the lowest level of education (age-adjusted ratio of the RR [RRR], 1.24 [1.09-1.41]). For stroke, the pooled age-adjusted RR for stroke for lowest versus highest education level was 1.34 (1.07-1.69) for women and 1.53 (1.27-1.86) for men, with no evidence of a difference by sex (age-adjusted RRR was 0.93 [0.72-1.18]). The pooled age-adjusted RR for CVD for the lowest versus highest level of education was 1.66 (1.43-1.92) for women, and 1.42 (1.25-1.63) for men; level of education was 1.18 (1.03-1.36). Women with the lowest level of education were at an 18% higher excess risk of CVD compared to men with the lowest level of education (age-adjusted RRR, 1.18 [1.03-1.36]). Similar results were observed for other markers of SES for all three outcomes.


The authors concluded that reduction of socioeconomic inequalities in CHD and CVD outcomes might require different approaches for men and women.


These data suggest that women with lower levels of education may be at increased risk for adverse outcomes including CHD and CVD. Efforts to reduce SES disparities will likely improve CVD health among both women and men.

Clinical Topics: Prevention, Atherosclerotic Disease (CAD/PAD)

Keywords: Cardiovascular Diseases, Coronary Artery Disease, Educational Status, Income, Occupations, Outcome Assessment (Health Care), Primary Prevention, Risk, Sex Characteristics, Socioeconomic Factors, Social Class, Stroke, Vascular Diseases, Women

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