Cardiovascular
Association Between COVID-19 and Cardiovascular Disease Across Income Levels: Analysis of BRFSS Annual Survey Data 2022 Kareem Khairy* Kareem Khairy Amirah Ellis-Gilliam Jee Won Park
COVID-19 may be associated with cardiovascular disease (CVD) as both conditions share critical risk factors. Further, socioeconomic status (SES) (e.g., income) strongly predicts premature morbidity and mortality, with lower SES linked to higher CVD mortality and poorer CVD risk factor profiles. Thus, this study assesses the relationship between COVID-19 and CVD overall, and by income levels.
This cross-sectional study employed secondary data analysis using the 2022 Behavioral Risk Factor Surveillance System (BRFSS) dataset, with a sample size of 445,132 participants (age ≥18 years, 51.4% female, and 61.2% White adults). Multivariable logistic regression analyses, incorporating survey weights, were performed while adjusting for potential confounders. We also assessed for effect measure modification (EMM) by income levels (low: <$25,000, middle: $25,000-$75,000, high: >$75,000).
The adjusted OR (95% CIs) for CVD among those who tested positive versus did not test positive for COVID-19 was 1.07 (95% CI: 1.00-1.14). EMM assessment by income levels indicated that strong positive associations between COVID-19 and CVD among those who reported low and middle income were observed (ORs (95% CIs): 1.18 (1.03-1.35) and 1.13 (1.03-1.24), respectively). However, a negative association was most compatible among those who reported high income (OR (95% CI): 0.92 (0.83-1.02)).
We found that income is an effect modifier in the relationship between COVID-19 and CVD. Positive associations in lower income groups and the negative association in the high income group underscores the influence of SES factors on the COVID-19-CVD relationship. Our findings may indicate the vulnerability of economically disadvantaged populations to the CVD consequences of a positive COVID-19 diagnosis. Additional prospective studies should be conducted to identify if there are underlying health conditions among lower income groups that influences adverse CVD outcomes among those who are susceptible to COVID-19.
