Социальные детерминанты здоровья выявили пять групп риска смертности при фибрилляции предсертий

Five social determinants of health (SDOH) vulnerability patterns were identified in atrial fibrillation (AF) and are associated with mortality and cardiovascular trajectories. These findings were published in the Journal of the American Heart Association. Atrial fibrillation is associated with elevated risk for major adverse cardiovascular events (MACE). Growing evidence suggests that SDOH factors play an important role in cardiovascular outcomes. Investigators analyzed data collected in the UK Biobank from 2006 to 2010. Adults (N=3842) aged 40 to 69 years who were diagnosed with AF within 2 years before (n=1944) or after (n=2614) study enrollment were evaluated for the composite MACE and all-cause mortality outcome on the basis of 15 SDOH variables. The study population comprised 64.8% men. Most of the cohort (44.8%) was aged 65 years or older, 3.3% were ethnic or racial minorities, 36.3% had obesity, 54.7% smoked, and 47.7% consumed alcohol. The association between SDOH vulnerability and adverse cardiovascular outcomes was more pervasive among men, who exhibited elevated risk across multiple vulnerability classes… During a median follow-up of 11.2 years, 29.1% of men and 21.3% of women experienced the composite outcome. In the SDOH cluster analysis, 5 distinct groups were identified: - Cluster 1 (n=972) had the most favorable profile, with general low vulnerability; - Cluster 2 (n=1023) primarily comprised individuals with lower household income (100%) and high unemployment (80.8%); - Cluster 3 (n=475) experienced high material deprivation (92.6%) and local crime rates (86.9%); - Cluster 4 (n=831) had high poverty rates (92.7%) and the lowest rate of social isolation (12.3%); and, - Cluster 5 (n=541) was the most vulnerable group, with high rates of low income (99.6%), emotional stress (70.1%), living alone (61.2%), and material deprivation (99.1%). Stratified by biological sex, the proportion of men was lowest in cluster 2 (58.6%) and highest in cluster 1 (72.5%). Stratified by race and ethnicity, the proportion of patients who self-reported as a racial or ethnic minority was lowest in cluster 1 (1.6%) and highest in cluster 3 (7.2%). In the survival analysis, rates of the composite outcome differed between clusters (P <.001), with the least favorable outcome observed in cluster 5 and the most favorable outcome observed in clusters 3 and 1. Compared with cluster 1, women in cluster 5 (hazard ratio [HR], 1.84; 95% CI, 1.22-2.76) and men in clusters 5 (HR, 2.14; 95% CI, 1.69-2.72), 4 (HR, 1.36; 95% CI, 1.08-1.71), and 2 (HR, 1.37; 95% CI, 1.09-1.71) were at elevated risk for the composite outcome. In a sex-specific clustering sensitivity analysis, 3 SDOH clusters were identified among women, in which no low-vulnerability class (cluster 1) was identified, and 4 classes were identified among men. The outcome risks for each sex-specific cluster were consistent with risks identified in the main analysis. Outcome-specific analyses demonstrated similar relationships with SDOH vulnerability profiles. This study was limited by assessing SDOH variables at a single time point. The study investigators concluded, “…this study demonstrates that SDOH cluster into 5 distinct vulnerability profiles among individuals with AF, with distributional differences by sex. The association between SDOH vulnerability and adverse cardiovascular outcomes was more pervasive among men, who exhibited elevated risk across multiple vulnerability classes, whereas women showed significant risk elevation only at the highest combined vulnerability threshold.” Disclosure: This project received funding from the Canadian Institute of Health. Investigators reported no conflicts of interest. Please see the original reference for full disclosures. This article originally appeared on The Cardiology Advisor References: Zhou Y, Houle J, Raparelli V, Norris CM, Pilote L. Clustering of social determinants of health and their association with adverse cardiovascular outcomes in atrial fibrillation. J Am Heart Assoc. Published online July 10, 2026. doi:10.1161/JAHA.126.049128