Socioeconomic disadvantage and cardiovascular outcomes in patients with established heart disease: A systematic review.

Socioeconomic disadvantage, reflected by low income, limited education, and neighborhood deprivation, is increasingly recognized as a determinant of cardiovascular outcomes. This systematic review synthesized evidence from 29 studies (2015-2025) on the association between socioeconomic indicators and mortality, hospital readmissions, and recurrent events in adults with established cardiovascular disease (CVD). Across diverse populations, socioeconomic disadvantage was consistently associated with significantly higher mortality (hazard ratios, 1.20-2.23) and increased hospitalizations or readmissions, independent of traditional risk factors. Disparities were observed across health systems and specific conditions, such as neighborhood deprivation leading to 63% higher 30-day mortality in valvular heart disease. Behavioral risk factors only partially accounted for the gradients. Socioeconomic disadvantage is a robust, independent predictor of adverse CVD outcomes, underscoring the need to integrate social determinants into risk assessment and treatment planning.