The relation between socioeconomic status and societal development with cardiovascular disease – A systematic review and meta-analysis on global data

Background While socioeconomic status (SES) is recognized as a significant determinant of cardiovascular disease (CVD), the strength and direction of this association vary across studies and with stages of societal development. This meta-analysis of global data aimed to evaluate the relationship between SES domains and CVD outcome while examining the influence of measures on country-level for social development. Methods The PubMed database was systematically searched for studies published between January 2000 and October 2024, investigating associations between SES domain (income, education, and occupation) and cardiovascular outcome, including stroke and myocardial infarction. The analysis incorporated macro-level determinants, including the Gini index, global quality infrastructure index, median age, and life expectancy. Multivariate meta-regression models was used to account for effect size dependencies, and heterogeneity was assessed using I 2 statistics. The systematic review and meta-analysis was pre-registered at http://www.crd.york.ac.uk (registration number: 651376). Results The analysis included 50 studies encompassing >7 million individuals with some degree of overlap. Education showed the strongest association with CVD outcomes (β=0.40, 95%CI [0.37; 0.43], p