Modifiable Risk Factors Mediate Associations Between Socioeconomic Position and Cardiovascular Disease Morbidity and Mortality
Bibliographic record
Abstract
Morbidity and mortality from cardiovascular diseases (CVDs) are higher among individuals with a lower, compared to those with a higher socioeconomic position (SEP). However, the contribution of modifiable risk factors to these inequities is not known. This study aimed to examine whether and to what extent modifiable risk factors mediate associations between SEP and CVD morbidity and mortality in a nationally representative sample of Canadian adults. We used a population-based prospective observational cohort design whereby participants who completed the Canadian Community Health Survey (2000–2011; n = 289,800) were followed longitudinally for CVD morbidity and mortality using administrative health and mortality data in the Discharge Abstract Database and the Canadian Mortality Database until 31 March 2013. Participants were included if they were at least 35 years of age and did not self-report CVD at the time of survey administration. The exposure of interest was SEP, which was measured as a latent variable consisting of annual household income and educational attainment. Potential mediators included smoking, physical inactivity, obesity, diabetes, and hypertension. The primary outcome of interest was CVD morbidity and mortality, which was defined as the first fatal or nonfatal CVD event that occurred during follow-up (6.2 years). Generalized structural equation modeling was used to test the mediating effects of modifiable risk factors in associations between SEP and CVD morbidity and mortality. SEP was associated with CVD morbidity and mortality. Modifiable risk factors mediated 80% of associations between SEP and CVD morbidity and mortality. Smoking was the most important mediator of these associations. Obesity mediated associations between SEP and CVD individually and jointly with diabetes or hypertension. These findings point to modifiable risk factors as potential targets for interventions to reduce inequities in CVD morbidity and mortality. Knowledge of pathways linking SEP with CVD is essential to inform targeted interventions to reduce socioeconomic inequities in CVD morbidity and mortality. This study was funded by a Libin Cardiovascular Research Institute of Alberta Innovation Seed Grant and the Petro-Canada Young Innovator Award in Community Health.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".