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Publications

Journal Article Epublish

PubMed: 42610040 DOI: 10.1016/j.cjco.2026.03.014

Sex-Focused Evaluation of Income and Education and the Risk of Atherosclerotic Cardiovascular Diseases Within a Universal Healthcare Context.

CJC Open 8(8):999-1009

Authors: Kate Haichin, David Alter, Paul Poirier, Jiayi Ni, Jean-Claude Tardif, Shaun G Goodman, Andrew Yan, Dennis Ko, Marc-André d'Entremont, Patrick R Lawler, Marco Spaziano, Abhinav Sharma, George Thanassoulis, Jean-Pierre Dery, Michel Nguyen, Samer Mansour, Douglas S Lee, Erick Schampaert, Thao Huynh

Affiliations

  • McGill University Health Centre, Montreal, Quebec, Canada.
  • Toronto Rehabilitation Institute at University Health Network, Toronto, Ontario, Canada.
  • Institut de cardiologie et pneumologie du Québec, Quebec City, Quebec, Canada.
  • Montreal Heart Institute, Montreal, Quebec, Canada.
  • Montreal Heart Institute Research Centre, Montreal, Quebec, Canada.
  • St. Michael's Hospital, Toronto, Ontario, Canada.
  • Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada.
  • Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
  • Institute for Clinical Evaluation Sciences (ICES), Toronto, Ontario, Canada.
  • Population Health Research Institute, Hamilton, Ontario, Canada.
  • McGill University Health Centre, Montreal, Quebec, Canada. Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.
  • Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.
  • Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, Quebec, Canada.
  • Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada.
  • Peter Munk Cardiac Centre at University Health Network, Toronto, Ontario, Canada.
  • Toronto General Hospital Research Institute, Toronto, Ontario, Canada.
  • Hôpital du Sacré-Cœur-de-Montréal, Montreal, Quebec, Canada.

Abstract

BACKGROUND

Although education and income are established determinants of atherosclerotic cardiovascular disease (ASCVD), whether sex differences in ASCVD risk are associated with these factors within a universal public healthcare system is unclear. We examined the independent associations of income and educational attainment with incident ASCVD and their potential variations by sex in Quebec, Canada.

METHODS

CARTaGENE is an ongoing prospective cohort study. We completed Cox models to estimate hazard ratios (HRs) for incident ASCVD, stratified by annual household income and educational attainment, among female and male participants without prior ASCVD. The primary endpoint was time to first ASCVD event.

RESULTS

There were 17,626 participants with a mean age of 54 ± 8 years (52% female), followed for a median of 6.6 years (2009-2016). Females with the lowest level of education, without collegiate education, had a 61% increase in the hazard of incident ASCVD compared to females with the highest level of education, with university studies (hazard ratio [HR]: 1.61; 95% confidence interval [CI]: 1.15, 2.26). Compared to those with an annual household income of ≥ CAD100,000, males with an annual household income of < CAD50,000 had a 61% increase in the hazard of incident ASCVD (HR:1.61; 95% CI: 1.23, 2.11).

CONCLUSIONS

Within a public healthcare system and with relatively affordable medication coverage, we still observed inequalities in ASCVD risk associated with educational attainment and household income. Future research is needed to confirm the potential sex differences in the impacts of educational attainment and income on the risk of ASCVD.

MeSH

Cardiovascular Diseases, Income, Sex Characteristics, Sex, Education, Sex Differences