The Lead Episode 115: A Discussion of Socioeconomic position and sudden cardiac death: A Danish nationwide study.-EP Europace (visual aid)

EP Europace (visual aid)

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This nationwide Danish study (2010) investigated the association between socioeconomic position (SEP) and incidence of all-cause mortality (ACM) and sudden cardiac death (SCD) among the general population of approximately 5.4 million. Using detailed registry data, the authors measured SEP by household income and highest educational attainment and analyzed their relation to ACM and SCD risks, adjusting for age, sex, and comorbidities.<br /><br />Key findings include:<br /><br />- There were 53,452 deaths in 2010, with 6,820 classified as SCDs.<br />- Incidence rates of both ACM and SCD increased with age and were significantly higher in lower socioeconomic groups.<br />- The greatest disparity in SCD incidence was between the lowest and highest education levels, with an incidence rate ratio (IRR) of 5.1.<br />- Comparing the lowest to the highest income quartile, adjusted hazard ratios (HR) showed a 2.17-fold increased risk of ACM and a 1.72-fold increased risk of SCD.<br />- These associations persisted independently of baseline comorbidities and other adjustments.<br />- The relationship between SEP and SCD risk remained significant despite Denmark’s universal healthcare system, indicating factors beyond healthcare access contribute to outcome disparities.<br />- Behavioral risk factors and societal influences, such as unequal healthcare quality, health literacy, and lifestyle differences, may partially mediate these disparities.<br />- The study highlights that SEP may be an important but underrecognized factor in SCD risk stratification and prevention.<br /><br />Strengths of the study include large sample size, comprehensive national death adjudication process, robust income data averaged over 10 years, and analysis within a healthcare system with minimal financial access barriers. Limitations include lack of behavioral and psychosocial data and potential misclassification of SCD cases.<br /><br />Clinical implications suggest targeted prevention and intervention strategies focused on low SEP populations and the potential benefit of incorporating SEP into SCD risk prediction models. Further research is warranted to elucidate mechanisms underlying the socioeconomic disparities in SCD risk.<br /><br />In conclusion, this study demonstrates a strong inverse association between socioeconomic position (income and education) and the risk of sudden cardiac death and all-cause mortality in Denmark, independent of comorbidities, underscoring the need for equitable healthcare approaches and further investigation into mediating factors.

Keywords

socioeconomic position

sudden cardiac death

all-cause mortality

Denmark

income disparities

education level

incidence rate ratio

hazard ratio

healthcare access

risk stratification