Socioeconomic inequalities in developing cardiometabolic diseases and transition to depression: A trajectory analysis of large-scale population-based study

Abstract

Existing evidence demonstrates a high risk of developing depression in patients with cardiometabolic diseases (CMDs). However, it remains unclear whether socioeconomic inequality exacerbates the progression. We aimed to quantify the role of socioeconomic status (SES) in the progression from healthy to CMDs and their transitions to depression. A total of 376 610 participants (age 37–73 years) free from CMDs of interest, including type 2 diabetes (T2D), coronary heart disease (CHD) and stroke, from the ongoing UK Biobank study between 2006 and 2010 were included at baseline. Potential various SES groups were derived from latent class analysis using family income level, employment status and education attainment. In latent class analysis, three distinctive levels of SES (low, medium, and high) were identified. During the 15-year follow-up, we found significant associations were found between low SES and different progression stages of CMDs. In multivariate models, the hazard ratios (95 % confidence intervals) for low SES vs. high SES were 1.62 (1.53–1.71), 1.23 (1.17–1.29) and 1.25 (1.13–1.38) for transitions from healthy to T2D, CHD and stroke, and 2.17 (2.03–2.30), 1.63 (1.30–2.03), 1.62 (1.30–2.03), 1.70 (1.11–2.60) for risk of transition to depression from healthy, T2D, CHD and stroke, respectively. Socioeconomic inequalities were associated with almost all transition stages from healthy to CMDs, subsequently to depression, with different magnitude of associations. These findings support the need for targeted screening programs for depression in CMD patients, and policy interventions addressing socioeconomic inequalities through improved access to healthcare, education, and economic opportunities for disadvantaged populations.