Accuracy of Cardiovascular Risk Prediction Varies by Neighborhood Socioeconomic Position

J. David Spence

doi:10.7326/L18-0007

Letters |1 May 2018

Accuracy of Cardiovascular Risk Prediction Varies by Neighborhood Socioeconomic Position

J. David Spence, MD

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TO THE EDITOR:

Dalton and colleagues (1) found a greater underestimation of cardiovascular risk among persons in the most economically disadvantaged neighborhoods. As would be expected, the prevalence of smoking was highest in this population (28.4%) and lowest in the most affluent neighborhoods (9%). This gradient was the most striking among the risk factors and may largely account for the higher prevalence of coronary artery disease and peripheral vascular disease among the most disadvantaged persons.

Although the model adjusted for smoking, it did not account for passive smoking (which is understandable considering that this element is difficult to assess). Because there are far more smokers in disadvantaged neighborhoods, it is probable that economically disadvantaged persons would also have more exposure to passive smoke. Bonita and associates reported a 6-fold increase in stroke risk in smokers and a 1.8-fold increase among persons passively exposed to smoke (2). Perhaps at least part of the underestimation of risk may be related to passive smoking.

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2018 American College of Physicians

Letters |1 May 2018

Accuracy of Cardiovascular Risk Prediction Varies by Neighborhood Socioeconomic Position

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Letters |1 May 2018

Accuracy of Cardiovascular Risk Prediction Varies by Neighborhood Socioeconomic Position

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