The Canadian journal of cardiology · 2026
Neighborhood-Level Material Resources and Risk of Cardiovascular Events in Patients With Atherosclerotic Cardiovascular Disease.
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Sheth Maya S, Jeong Irene, Chu Anna, Basque Shalane, Fang Jiming, McNaughton Candace D, Ko Dennis T, Abdel-Qadir Husam, Lee Douglas S, Udell Jacob A
Аннотация
BACKGROUND: Disparities in atherosclerotic cardiovascular disease (ASCVD) outcomes may persist despite universal health care. We examined the association among neighbourhood-level material resources, cardiovascular outcomes, and medication discontinuation among patients with established ASCVD.
METHODS: In this population-based cohort study using administrative data from Ontario, Canada (2019 to 2021), we included adults aged ≥ 66 years with ASCVD events in the previous 10 years. The exposure was neighbourhood-level material resources (quintiles; Q1 = most, Q5 = least). The primary outcome was a composite of all-cause death, myocardial infarction (MI), or stroke. Secondary outcomes included individual components; heart failure (HF); coronary revascularization; and discontinuation of statins, ezetimibe, sodium-glucose cotransporter-2 inhibitors (SGLT2i), and glucagon-like peptide-1 receptor agonists (GLP-1RA).
RESULTS: Among 195,742 individuals, those in the least resources neighbourhoods (Q5) had higher hazards of the composite outcome (hazard ratio [HR], 1.19; 95% confidence interval [CI], 1.16-1.23) and all-cause death (HR, 1.23; 95% CI, 1.18-1.27) compared with Q1, with similar patterns observed for MI, stroke, and HF. Q5 residents also had higher hazards of discontinuation of statins (HR, 1.13; 95% CI, 1.03-1.24), ezetimibe (HR, 1.26; 95% CI, 1.07-1.49), SGLT2i (HR, 1.20; 95% CI, 1.05-1.37), and GLP-1RA (HR, 1.14; 95% CI, 1.01-1.29).
CONCLUSIONS: Despite universal health care, lower neighbourhood-level material resources were independently associated with higher rates of cardiovascular outcomes and medication discontinuation among older adults with ASCVD, highlighting persistent inequities in secondary prevention.
METHODS: In this population-based cohort study using administrative data from Ontario, Canada (2019 to 2021), we included adults aged ≥ 66 years with ASCVD events in the previous 10 years. The exposure was neighbourhood-level material resources (quintiles; Q1 = most, Q5 = least). The primary outcome was a composite of all-cause death, myocardial infarction (MI), or stroke. Secondary outcomes included individual components; heart failure (HF); coronary revascularization; and discontinuation of statins, ezetimibe, sodium-glucose cotransporter-2 inhibitors (SGLT2i), and glucagon-like peptide-1 receptor agonists (GLP-1RA).
RESULTS: Among 195,742 individuals, those in the least resources neighbourhoods (Q5) had higher hazards of the composite outcome (hazard ratio [HR], 1.19; 95% confidence interval [CI], 1.16-1.23) and all-cause death (HR, 1.23; 95% CI, 1.18-1.27) compared with Q1, with similar patterns observed for MI, stroke, and HF. Q5 residents also had higher hazards of discontinuation of statins (HR, 1.13; 95% CI, 1.03-1.24), ezetimibe (HR, 1.26; 95% CI, 1.07-1.49), SGLT2i (HR, 1.20; 95% CI, 1.05-1.37), and GLP-1RA (HR, 1.14; 95% CI, 1.01-1.29).
CONCLUSIONS: Despite universal health care, lower neighbourhood-level material resources were independently associated with higher rates of cardiovascular outcomes and medication discontinuation among older adults with ASCVD, highlighting persistent inequities in secondary prevention.