Gendered social determinants of health and risk of major adverse outcomes in atrial fibrillation

Introduction

Atrial fibrillation (AF) is associated with an increased risk of adverse outcomes. Clinical risk factors have been identified as predictors of such outcomes, but social determinants of health (SDOH) may also play a role. We evaluated the associations between gendered SDOH (unevenly distributed between sexes) and adverse outcomes in AF.

Methods

This is a retrospective cohort study using data from a European registry of AF patients from 250 centers and twenty-seven countries. Gendered SDOH included education, living status, subscales of the EQ-5D-5L questionnaire, behavioral factors, and country-level gender inequality index (GII). The primary outcome was a composite of major adverse cardiovascular events and all-cause mortality. We used multivariate logistic regression models to identify associations between SDOH and the primary outcome.

Results

The study population comprised of 11,096 patients (mean age 69.2 years; 40.7 % females), with 75.6 % of patients having a high-risk CHA₂DS₂-VASc score. Most participants had secondary education, were physically inactive, lived in countries with gender equity and reported at least moderately elevated quality of life measures; they were less likely to live alone, smoke or drink alcohol. After adjustment for clinical factors, not having any post-secondary education (OR:1.17 95 %CI:1.05–1.28), reporting poorer health status (OR:1.08 95 %CI:1.05–1.11), living in a country with a higher GII (higher gender inequity) (OR:1.12 95 %CI:1.03–1.22 each 0.100), reporting reduced mobility (OR:1.18 95 %CI:1.02–1.38) and reduced self-care (OR:1.35;95 %CI:1.14–1.61) were independently associated with worse outcomes.

Conclusions

Gendered SDOH are independently associated with adverse events in patients with AF. These factors should be considered for assessment of risk and as potential targets for interventions to improve outcomes.

Condensed Abstract

Atrial fibrillation (AF) is associated with adverse outcomes and social determinants of health (SDOH), which are gendered, may predict adverse outcomes in AF. We used a registry of AF patients from 27 European countries. Multivariate logistic regressions were used to investigate the associations between gendered SDOH and the primary outcome, a composite of major adverse cardiovascular events and all-cause mortality. Several SDOH were independent predictors: no higher education (OR:1.17;95 %CI:1.05–1.28), lower health (OR:1.08;95 %CI:1.05–1.11), higher GII (OR:1.12;95 %CI:1.03–1.22 each 0.100), reduced mobility (OR:1.18;95 %CI:1.02–1.38) and reduced self-care (OR:1.35;95 %CI:1.14–1.61). Gendered SDOH are independently associated with adverse events in AF.