Socioeconomic deprivation and reclassification of ischemic stroke risk in patients with atrial fibrillation: A report from UK Biobank

초록

BACKGROUND: The impact of socioeconomic deprivation on stroke risk stratification among patients with atrial fibrillation (AF) remains underexplored, particularly across its specific domains. OBJECTIVE: We investigated the association between socioeconomic deprivation and ischemic stroke risk in AF. METHODS: We included 21,893 United Kingdom Biobank participants with newly diagnosed AF, excluding those with prior stroke or baseline use of antithrombotic. Socioeconomic status was assessed using the Index of Multiple Deprivation (IMD), comprising 7 domains: income, employment, health, education, crime, housing, and living environment. Individuals in the top 5% were defined as the highly-deprived group. The primary outcome was incident ischemic stroke. RESULTS: Over a median follow-up of 3.9 years (1.6-7.2), the highly-deprived group had a higher incidence of stroke than the control group (16.09 vs 8.56 per 1000 person-years), with a graded linear increase in the hazard ratio (HR) for stroke across the full range of IMD scores. Socioeconomic deprivation was independently associated with increased stroke risk (adjusted HR 1.75, 95% confidence interval 1.24-2.46, P = .001). Income, employment, health, and living environment deprivation were most strongly associated with increased stroke risk. In patients with CHA2DS2-VA score 0-1, stroke incidence in the highly-deprived group exceeded that of control individuals with score 2-3. Adding IMD to the CHA2DS2-VA score improved the C-index from 0.595 to 0.613 (P = .027) and net reclassification index by 14.6% (P = .002). CONCLUSIONS: Socioeconomic deprivation independently predicts ischemic stroke in AF and enhances risk stratification beyond clinical scores, highlighting the value of incorporating socioeconomic metrics into risk prediction, thus impacting clinical decision. Copyright © 2026 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

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