# Associations of Socioeconomic Status With Cardiorenal Metabolic Multimorbidity: Evidence From the UK Biobank Cohort

## TL;DR

This study shows that people with lower socioeconomic status are more likely to develop and progress through multiple cardiorenal metabolic diseases.

## Contribution

The study establishes socioeconomic status as a key factor in the incidence and progression of cardiorenal metabolic multimorbidity.

## Key findings

- Low socioeconomic status is independently associated with a higher risk of developing cardiorenal metabolic multimorbidity.
- Socioeconomic disparities are evident in disease progression from single to multiple cardiorenal metabolic conditions.
- Consistent results were found using different measures of socioeconomic status.

## Abstract

Cardiorenal metabolic multimorbidity (CRMM), defined as the coexistence of ≥2 conditions among cardiovascular disease, type 2 diabetes, and chronic kidney disease, imposes a substantial global health burden. Evidence linking socioeconomic status (SES) to CRMM and its progression remains limited, despite SES associations with individual cardiorenal metabolic diseases (CRMDs).

The objective of the study was to examine the associations of SES with CRMM incidence and progression.

This prospective cohort study included participants in the UK Biobank. SES (income, education, and employment) was categorized into 3 levels via latent class analysis and summed score. Cox regression models were employed to examine the association between SES and the risk of CRMM, whereas multistate modeling evaluated the dynamic progression of CRMM associated with SES.

During follow-up, 5,643 participants developed CRMM. Compared to high SES, low SES was independently associated with significantly elevated risks of CRMM (HR: 2.03; 95% CI: 1.82 to 2.27). Socioeconomic disparities were observed across all disease transitions, with low SES increasing progression risks from free of CRMD to first CRMD (HR: 1.45; 95% CI: 1.10-1.50), to CRMM (HR: 1.51; 95% CI: 1.43-1.49), and from existing cardiovascular disease (HR: 1.22; 95% CI: 1.12-1.33) or type 2 diabetes (HR: 1.48; 95% CI: 1.19-1.85) to CRMM. Consistent associations were confirmed using the summed SES score.

Our study establishes SES as a pivotal determinant of CRMM incidence and progression. This underscores the necessity of integrating SES into public health strategies to mitigate the CRMM burden, even in individuals with 1 CRMD.