Abstract Body (Do not enter title and authors here): Background Socioeconomic disadvantage is associated with worse CV outcomes. However, whether living in a disadvantaged neighborhood is associated with both the presence of coronary plaque identified by Coronary CTA (CCTA) and subsequent MACE is not well defined.
Aims To assess whether residence in a disadvantaged neighborhood predicts (1) plaque presence and stenosis severity and (2) long-term MACE after adjusting for plaque burden.
Methods We included patients who underwent clinically indicated CCTA from 2006 to 2021. Home addresses were geocoded and mapped to their census block groups. The Area Deprivation Index (ADI) was used to assess neighborhood-level socioeconomic disadvantage from 1 to 10. Based on ADI, patients were grouped into low (1-2), medium (3-5), and high neighborhood deprivation (6-10). The presence of plaque (present vs absent) and severity (no plaque or stenosis [0%], nonobstructive [1-49% stenosis], and obstructive [≥50% stenosis]) were categorized on CCTA. We used logistic regression to assess the association of plaque burden and ADI, and Cox regression to assess the association of ADI and MACE, adjusting for CAD severity and risk factors.
Results We included 26,165 patients with a median age of 58 years (IQR 49-67). Of these, 44.5% were female, and 57.8%, 52.8%, and 16.7% had a history of hypertension, dyslipidemia, and diabetes, respectively. The median follow-up after CCTA was 3.9 years (IQR 1.7-7.4). Living in highly disadvantaged neighborhoods was significantly associated with presence of plaque (OR 1.20 [95% CI 1.11-1.30] p<0.001) and obstructive stenosis (OR 1.20 [95% CI 1.11-1.30] p<0.001). Over follow-up, individuals living in medium ADI neighborhoods had a 16% increased hazard of MACE [adjusted HR 1.16 (95% CI 1.02-1.31) p=0.019], and those living in highly disadvantaged neighborhoods had a 20% increased hazard of MACE [adjusted HR 1.20 (95% CI 1.05-1.37) p=0.007] compared to individuals living in the most advantaged neighborhoods.
Conclusion Residence in medium and highly disadvantaged neighborhoods was associated with an increased prevalence of plaque and obstructive stenosis on CCTA as well as higher rates of MACE, even after adjusting for traditional CV risk factors.