(P243) SEX-FOCUSED EVALUATION OF INCOME AND EDUCATION INEQUALITIES ASSOCIATED WITH THE RISK OF ATHEROSCLEROTIC CARDIOVASCULAR DISEASES WITHIN A UNIVERSAL HEALTHCARE SYSTEM: INSIGHTS FROM THE CARTAGENE STUDY

Background: Although education and income and their impacts on cardiovascular disease have previously been studied, their potential sex interactions have not previously been evaluated within a universal healthcare system. Consequently, we sought to examine the independent associations of income and education with the risk of incident ASCVD and their potential variations between men and women in Quebec, Canada.

METHODS AND RESULTS: The CARTaGENE Study is an ongoing prospective cohort study (2009-2016). We completed Cox models to identify the incident ASCVD risk associated with annual household income and education in individuals without prior ASCVD. The primary composite endpoint was time to the first ASCVD event (cardiovascular death, acute coronary syndrome, coronary revascularization, ischemic stroke/transient ischemic attack, or an ischemic limb event or intervention).

There were 17,626 participants with a mean age of 54 years ± 8 years (52% female) followed for a median of 6.6 years. The adjusted ASCVD risk in women with completion of less than high school increased by 88% as opposed to women with at least collegial education. Compared to the highest income quartile, men within the lower income quartiles had a 39%-52% increase in ASCVD risk. There were interactions between the female sex and level of education; male sex and low annual household income (p=0.001).

Conclusion: Within a universal healthcare context and extensive drug coverage, lower income and education remained associated with increased risks of ASCVD. Women with low level of education and men with lower annual household income have the highest ASCVD risk. On the other hand, men with low annual income are at increased risk of incident ASCVD. Public health strategies aiming to decrease the ASCVD risk need to target these high-risk populations and be adapted differently for men and women.