Neighborhood-level material resources and risk of cardiovascular events in patients with atherosclerotic cardiovascular disease

Background — Disparities in atherosclerotic cardiovascular disease (ASCVD) outcomes may persist despite universal health care. We examined the association between neighbourhood-level material resources, cardiovascular outcomes, and medication discontinuation among patients with established ASCVD.

Methods — In this population-based cohort study using administrative data from Ontario, Canada (2019–2021), we included adults aged ≥66 years with an ASCVD event in the prior 10 years. The exposure was neighbourhood-level material resources (quintiles; Q1=most, Q5=least). The primary outcome was a composite of all-cause death, myocardial infarction (MI), or stroke. Secondary outcomes included individual components, heart failure (HF), coronary revascularization, and discontinuation of statins, ezetimibe, sodium-glucose cotransporter-2 inhibitors (SGLT2i), and glucagon-like peptide-1 receptor agonists (GLP-1RA).

Results — Among 195,742 individuals, those in the least resources neighbourhoods (Q5) had higher hazards of the composite outcome (HR 1.19, 95% CI 1.16–1.23) and all-cause death (HR 1.23, 95% CI 1.18–1.27) compared with Q1, with similar patterns observed for MI, stroke, and HF. Q5 residents also had higher hazards of discontinuation of statins (HR 1.13, 95% CI 1.03–1.24), ezetimibe (HR 1.26, 95% CI 1.07–1.49), SGLT2i (HR 1.20, 95% CI 1.05–1.37), and GLP-1RA (HR 1.14, 95% CI 1.01–1.29).

Conclusion — Despite universal health care, lower neighbourhood-level material resources were independently associated with higher rates of cardiovascular outcomes and medication discontinuation among older adults with ASCVD, highlighting persistent inequities in secondary prevention.