Addressing Public Health Inequities: Socioeconomic Disparities in Cardiovascular Disease Incidence

Abstract Cardiovascular disease (CVD) is a major public health issue, causing over 60 million potential years of life lost annually in Europe (Townsend et al., 2022). While CVD prevalence is linked to neighborhood Socioeconomic Status (SES), longitudinal studies in Spain remain limited. This study estimates age-adjusted CVD incidence in Valencia (Spain) (2015-2022), analyzing variations by sex and SES to assess health disparities. Electronic health records from SIA-GAIA and SES data from Spanish Statistical Office (INE) were analyzed. The primary outcome was the first recorded CVD diagnosis (ICD-9/10). The study included residents ≥40 years from 26 Valencia postal codes. Prevalent cases before 2015 and recurrent cases were excluded, forming a retrospective cohort. Census tracts were clustered into income quartiles. Incidence was estimated from a Poisson regression, adjusting for age by sex and neighbourhood SES strata. The general CVD incidence (2015-2022) was 6.29 (95% CI: 6.02 to 6.57) cases per 1,000 person-years. Age-adjusted incidence decreased with higher neighborhood SES, from 10.1 (9.65-10.7) to 7.9 (7.51-8.32) in men and 5.28 (5.02-5.56) to 4.11 (3.9-4.33) in women. These findings highlight a socioeconomic gradient, with a higher disease burden in disadvantaged neighborhoods. This study shows a socioeconomic gradient in CVD incidence in Valencia (2015-2022), with higher rates in lower-SES areas and higher incidence in men. It underscores the need to address structural inequalities through public health actions as: a. Targeted risk reduction programs (smoking cessation, diet, exercise). b. Better primary care access for early screening. c. Policies to reduce income inequality and improve housing. d. Community-based CVD education and prevention. By addressing the underlying social and economic factors contributing to CVD, public health efforts can reduce health disparities and improve overall cardiovascular outcomes in Valencia. Key messages • CVD incidence in Valencia (2015–2022) followed a socioeconomic gradient, with higher rates in lower-SES areas, especially among men, highlighting the need for targeted public health interventions. • Reducing CVD disparities requires improved primary care access, risk reduction programs, and policies addressing income inequality, housing, and community-based prevention efforts.