Socioeconomic status, cardiovascular health and joint associations with incident cataract: a prospective study from UK Biobank

AIMS: To investigate the interaction and combined effects of cardiovascular health (CVH) and socioeconomic status (SES) on incident cataract risk. METHODS: This prospective cohort study included 236 248 UK Biobank participants free of cataract at baseline and with complete data on SES and CVH. Incident cataract was ascertained through hospital inpatient and self-reported records. SES was derived from household income, employment and education using latent class analysis, while CVH was assessed via the Life's Essential 8 (LE8) score. Cataract risk was evaluated using multivariable Cox regression, with interaction and joint effects analyses performed to assess the interplay between SES and CVH. RESULTS: This analysis involved 236 248 participants with an average age of 55.5 years (range: 38-73); 51.6% were female and 95.6% were of white ethnicity. Over a median follow-up period of 11.7 years, 26 791 participants (11.3%) developed cataract. Compared with the high SES group, participants with low SES had a significantly higher risk of cataract (HR, 1.30; 95% CI 1.25 to 1.35). Significant additive and multiplicative interactions between SES and CVH on cataract risk were observed. Better CVH substantially mitigated the adverse association of low SES with cataract. Notably, individuals with low SES and poor CVH showed the highest cataract risk (HR, 1.74; 95% CI 1.57 to 1.93) in contrast to those with high SES and optimal CVH. CONCLUSIONS: Implementing interventions aimed at enhancing both SES and CVH may prove beneficial in preventing or delaying cataract onset. Adhering to the LE8 guidelines to maintain optimal CVH has the potential to alleviate a significant portion of the excess cataract risk associated with socioeconomic disadvantage.