Abstract 4365485: Impact of Socioeconomic Status on All-Cause Mortality in Older Adults with Heart Disease: a Community-based Cohort Study in China

Background: Socioeconomic status (SES) influences the risk of heart disease (HD) in the general population. Yet, few community-based studies have assessed the impacts of various SES indicators on all-cause mortality among older adults with HD and the interaction effect between SES and HD on all-cause mortality in older communities. Methods: We examined data from a community-based cohort across five provinces in China, comprising 6,110 participants aged ≥60 years (806 with HD). Baseline assessments captured SES indicators (urban/rural residence, education, occupation, personal and family incomes, financial difficulties) and cardiovascular risk factors. HD was documented from doctor-diagnosis questionnaire. Mortality outcomes were ascertained through the cohort follow-up. Results: Over an average follow-up of 4.7 years, the cohort recorded 125 deaths among 806 participants with HD, and 902 deaths among participants without HD. Multivariable-adjusted Cox models showed significant SES-mortality associations in older adults with HD. Rural residents with HD had an elevated mortality risk (fully adjusted hazard ratio [HR] = 3.39, 95% CI: 1.90-6.06) compared to their urban counterparts. All-cause mortality was also significantly increased in older adults with HD who had financial problems over the past two years (HR = 2.71, 1.41-5.20) or an annual personal income <US$300 (HR = 2.21, 1.11-4.40). Fully adjusted analyses showed increased mortality among those with HD who had lower levels of education, occupation, income satisfaction, and family income by 27%-49%, though these did not reach conventional statistical significance. There were significant interaction effects between HD and both rural living and financial hardship on all-cause mortality in older adults. Conclusions: Rural living and financial difficulties emerge as key determinants of mortality disparities among older adults with HD in China. Strategies aimed at enhancing healthcare accessibility in rural communities and implementing targeted economic support to address health inequalities should be essential components of HD interventions.