Abstract
BACKGROUND: Neighbourhood socioeconomic disadvantage is a known determinant of cardiovascular disease (CVD) risk. However, its impact on subclinical atherosclerosis across the life course remains inadequately understood. This study examined the association between cumulative neighbourhood socioeconomic disadvantage from childhood to midlife and carotid artery plaques-a marker of subclinical atherosclerosis-independent of genetic and behavioral CVD risk factors. METHODS: We analysed data from 2,051 participants in the Cardiovascular Risk in Young Finns Study, a prospective cohort followed from childhood (mean age 10.7 years in 1980) to adulthood (mean age 48.6 years in 2018-2020). Neighbourhood disadvantage was derived from national grid-based socioeconomic data and computed cumulatively across childhood/adolescence, adulthood, and the entire life course. The number of carotid artery plaques (plaque count) were assessed by standardized ultrasound imaging. Multivariable Poisson regression models were used to evaluate associations, adjusting for age, sex, individual and parental socioeconomic status, genetic predisposition, and cardiovascular risk profiles. Mediation analyses assessed the role of ideal cardiovascular health (CVH) metrics. RESULTS: No cross-sectional association was found between current neighbourhood disadvantage and carotid plaque count. However, higher cumulative neighbourhood disadvantage over the life course was associated with increased plaque count (rate ratio [RR] ≈ 1.20 per 1 SD increase). This relationship persisted after controlling for parental carotid artery plaques, polygenic coronary artery disease risk score, and Framingham risk score. The effect was partially mediated by ideal CVH metrics, particularly smoking and blood pressure, which collectively explained up to 50% of the association. CONCLUSIONS: Long-term exposure to neighbourhood socioeconomic disadvantage beginning in childhood is associated with subclinical atherosclerosis in midlife independently of achieved socioeconomic position. Behavioural risk factors partially mediate this link, highlighting the importance of early and sustained interventions targeting both social environments and health behaviours to mitigate cardiovascular risk.