Life-Course Socioeconomic Status and Risk of Hospitalization for Heart Failure or Atrial Fibrillation in the Moli-sani Study Cohort

Abstract

Abstract We investigated the association of cumulative socioeconomic disadvantage (CSD) and socioeconomic status (SES) trajectories across the life course with the risk of first hospitalization for heart failure (HF) or atrial fibrillation (AF) and tested some biological mechanisms to explain such associations. Longitudinal analysis was conducted of 21,756 people without HF or AF who were recruited for the Moli-sani Study (2005–2010; Italy) and followed up for 8.2 years. CSD was computed using childhood SES, education, and adulthood SES indicators, and the same were used to define overall trajectories. A high level of disadvantage across the life course (CSD ≥ 8) was associated with increased risk of HF (hazard ratio (HR) = 2.58, 95% confidence interval (CI): 1.78, 3.74) or AF (HR = 1.57, 95% CI: 1.05, 2.33), as compared with lower CSD. All explanatory factors accounted for 18.5% and 24% of the excess of HF and AF risks, respectively, associated with CSD. For people with low childhood SES, advancements in education lowered their risk of HF (HR = 0.70, 95% CI: 0.48, 1.02) or AF (HR = 0.50, 95% CI: 0.28, 0.89), whereas achievements of adulthood SES were unlikely to contribute to disease reduction. In conclusion, a life-course–disadvantaged SES is an important predictor of first hospitalization for HF and AF; known risk factors partially explained the SES–disease gradient. Being in an upwardly mobile group is likely to mitigate the effect of poor childhood circumstances, especially through educational advancement.