Abstract
BACKGROUND: We aimed to explore the association of socioeconomic status (SES) and life's essential 8 (LE8) with cardiovascular disease (CVD) and all-cause mortality in north China. METHODS: A total of 91,365 adults from the Kailuan study were included in this study. Comprehensive individual SES, mainly including monthly household income, education, Occupation position, and community environment, was confirmed by latent class analysis. Furthermore, the mediation and combination effects of SES and LE8 on CVD and all-cause mortality were further assessed. The Cox regression model was conducted to estimate HRs and 95% CI. RESULTS: During about 13 years of follow-up, 7,646 cardiovascular events and 11,749 deaths were recorded. Relative to the high SES, there were decreased risks of CVD [HR (95% CI): 1.57(1.43-1.72)] and high all-cause death [HR (95% CI): 1.43(1.31-1.53)] in the low SES. The associations between SES and CVD [Mediation % (95% CI): 22.3 (16.4-30.4)] and mortality [Mediation % (95% CI): 10.1 (7.1-14.0)] were partially mediated by LE8 when comparing medium SES to high SES. Meanwhile, relative to high LE8, the elevated risk of death [HR (95% CI): 1.72(1.56-1.89)], and incident CVD [HR (95% CI): 3.34(2.91-3.83)] were detected in low LE8. Compared to participants who had the high SES and LE8, participants who had both the low SES and LE8 further increased the risk of CVD [HR (95% CI): 7.76(5.21-11.55)] and all-cause mortality [HR (95% CI): 2.80(2.19-3.58)]. CONCLUSION: Low SES was related to a higher risk of CVD and mortality in low- and middle-income countries, which was partially mediated by LE8.