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

Background: Although education and income are established determinants of atherosclerotic cardiovascular (ASCVD) disease, it remains unclear whether there are sex differences in ASCVD risk associated with these factors within a universal public healthcare system.We examined the independent associations of income and educational attainment with incident ASCVD and their potential sex variations in Quebec, Canada. Methods:The CARTaGENE Study is an ongoing prospective cohort study.We completed Cox models to estimate hazard ratios (HR) for incident ASCVD, stratified by annual household income and educational attainment, among females and males without prior ASCVD.The primary endpoint was time to the first ASCVD event.Results: There were 17,626 participants with a mean age of 54 years 8 years (52% females), followed for a median of 6.6 years (2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016).Females without collegiate education had a 61% increase in the hazard of incident ASCVD compared to females with university studies (Hazard ratio (HR: 1.61 (95% confidence intervals (CI): 1.15, 2.26).Compared to those with an annual household income of 100,000 CAD or more, males with an annual household income of less than 50,000 CAD had a 61% increase in the hazard of incident ASCVD (HR:1.61;95% CI: 1.23, 2.11). Conclusion:Within a public healthcare system and 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.