{
  "abstract": "Background Evidence of socioeconomic status (SES)-related health inequality is scarce in patients with cardiovascular diseases (CVDs) who need both lifestyle change and medical care, particularly in developing countries.Methods The study employed a nationwide population-based cohort design, covering all 31 provinces of Chinese mainland from September 2014 to March 2021. Participants aged 35–75 years with self-reported CVD diagnoses were included. Information on SES and lifestyle details were collected via a questionnaire, and the unequal mortality across SES groups and the mediating effects of lifestyles were explored.Results Among the 104 718 participants included, 27 943 (26.7%) were allocated to high SES, 35 802 (34.2%) were allocated to medium SES and 40 973 (39.1%) were allocated to low SES. During a mean follow-up of 48.9±18.9 months, 5010 deaths were recorded. Participants with low SES had a 65% (HR=1.65, 95% CI: 1.50 to 1.80) greater risk of all-cause death and a 95% (HR=1.95, 95% CI: 1.72 to 2.20) greater risk of CVD death in Chinese communities. A low SES with the worst lifestyle was associated with a significant increase in the risk of all-cause mortality by 172% (HR=2.72, 95% CI: 2.37 to 3.12) and CVD mortality by 218% (HR=3.18, 95% CI: 2.64 to 3.83) compared with a high SES with healthy lifestyle. The joint mediating effects of lifestyles on CVD mortality accounted for 19.6% (95%CI: 14.8% to 24.2%) of the excess mortality risk for individuals with low SES, and these effects varied by genders (p for interaction=0.013) and urbanity (p for interaction=0.004). Leisure-time physical activity was the strongest mediator, followed by dietary factors. For all-cause mortality, outcomes were similar to this.Conclusions Both SES-related health inequalities and lifestyle disparities should be comprehensively considered when caring for this population, and upstream structural interventions that integrate SES and lifestyle factors and are tailored to the target population are urgently needed.Trial registration number NCT02536456.",
  "authors": [
    {
      "affiliations": [
        "Shenzhen Clinical Research Center for Cardiovascular Diseases, Fuwai Shenzhen Hospital, Chinese Academy of Medical Sciences, Shenzhen, Guangdong, China"
      ],
      "name": "Yunfeng Wang"
    },
    {
      "affiliations": [
        "Shenzhen Clinical Research Center for Cardiovascular Diseases, Fuwai Shenzhen Hospital, Chinese Academy of Medical Sciences, Shenzhen, Guangdong, China"
      ],
      "name": "Ke Peng"
    },
    {
      "affiliations": [
        "National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China"
      ],
      "name": "Wei Xu"
    },
    {
      "affiliations": [
        "National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China"
      ],
      "name": "Xin Huang"
    },
    {
      "affiliations": [
        "Shenzhen Clinical Research Center for Cardiovascular Diseases, Fuwai Shenzhen Hospital, Chinese Academy of Medical Sciences, Shenzhen, Guangdong, China"
      ],
      "name": "Xiaoying Liu"
    },
    {
      "affiliations": [
        "Shenzhen Clinical Research Center for Cardiovascular Diseases, Fuwai Shenzhen Hospital, Chinese Academy of Medical Sciences, Shenzhen, Guangdong, China"
      ],
      "name": "Yichong Li"
    },
    {
      "affiliations": [
        "National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China"
      ],
      "name": "Jiapeng Lu"
    },
    {
      "affiliations": [
        "National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China"
      ],
      "name": "Yang Yang"
    },
    {
      "affiliations": [
        "National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China"
      ],
      "name": "Bowang Chen"
    },
    {
      "affiliations": [
        "Shenzhen Clinical Research Center for Cardiovascular Diseases, Fuwai Shenzhen Hospital, Chinese Academy of Medical Sciences, Shenzhen, Guangdong, China"
      ],
      "name": "Yu Shi"
    },
    {
      "affiliations": [
        "Shenzhen Clinical Research Center for Cardiovascular Diseases, Fuwai Shenzhen Hospital, Chinese Academy of Medical Sciences, Shenzhen, Guangdong, China"
      ],
      "name": "Guiyuan Han"
    },
    {
      "affiliations": [
        "National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China"
      ],
      "name": "Xiaoyan Zhang"
    },
    {
      "affiliations": [
        "National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China"
      ],
      "name": "Jianlan Cui"
    },
    {
      "affiliations": [
        "National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China"
      ],
      "name": "Lijuan Song"
    },
    {
      "affiliations": [
        "National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China"
      ],
      "name": "Aoxi Tian"
    },
    {
      "affiliations": [
        "National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China"
      ],
      "name": "Wang Runsi"
    },
    {
      "affiliations": [
        "National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China"
      ],
      "name": "Chunqi Wang"
    },
    {
      "affiliations": [
        "National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China"
      ],
      "name": "Yuan Tian"
    },
    {
      "affiliations": [
        "National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China"
      ],
      "name": "Yi Wu"
    },
    {
      "affiliations": [
        "National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China"
      ],
      "name": "Chunying Lin"
    },
    {
      "affiliations": [
        "National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China"
      ],
      "name": "Wenyao Peng"
    },
    {
      "affiliations": [
        "Shenzhen Clinical Research Center for Cardiovascular Diseases, Fuwai Shenzhen Hospital, Chinese Academy of Medical Sciences, Shenzhen, Guangdong, China",
        "National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China",
        "Central China Sub-center of the National Center for Cardiovascular Diseases, Zhengzhou, Henan, China"
      ],
      "name": "Xi Li"
    },
    {
      "affiliations": [
        "Shenzhen Clinical Research Center for Cardiovascular Diseases, Fuwai Shenzhen Hospital, Chinese Academy of Medical Sciences, Shenzhen, Guangdong, China",
        "National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China"
      ],
      "name": "Shengshou Hu"
    }
  ],
  "title": "Cardiovascular disease-specific and all-cause mortality across socioeconomic status and lifestyles among patients with established cardiovascular disease in communities of China: data from a national population-based cohort",
  "uid": "254583f3-4f98-57ad-824a-11232043ad3d"
}