Evidence map›Paper›PMID 41448845›Full record

ArticleOpen heart2025

Sex differences in the association of social determinants of health and adverse cardiovascular outcomes in patients with atrial fibrillation.

Yusheng Zhou, Jonathan Houle, Valeria Raparelli, Colleen M Norris, Louise Pilote

Abstract readComparative Study
In one paragraph

Article in Open heart, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
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0citing papers in PubMed
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1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Yusheng ZhouCentre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada.
Jonathan HouleCentre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada.
Valeria RaparelliDepartment of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy.ORCID http://orcid.org/0000-0002-2100-5682
Colleen M NorrisUniversity of Alberta, Edmonton, Canada.
Louise PiloteDepartment of Medicine, McGill University, Montreal, Canada louise.pilote@mcgill.ca.ORCID http://orcid.org/0000-0002-6159-0628

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundDespite anticoagulation, patients with atrial fibrillation (AF) experience persistent elevated cardiovascular risk, with conflicting evidence regarding sex-based outcome disparities. Social determinants of health (SDOH)-encompassing economic, psychosocial and environmental factors-demonstrate robust associations with cardiovascular outcomes and exhibit significant sex-specific patterns, yet remain understudied in AF populations. This study aimed to clarify sex differences in the association of SDOH and adverse cardiovascular outcomes in patients with AF.

methodsData came from the UK Biobank. Participants with AF enrolled between 2006 and 2010 were included. SDOH comprised economic, psychosocial and neighbourhood environmental factors. The primary outcome was a composite of major adverse cardiovascular events (ie, stroke/transient ischaemic attack, arterial thromboembolic events, myocardial infarction and cardiovascular mortality) and all-cause mortality. Sex-stratified, Cox proportional hazards models were used.

resultsAmong 3842 participants (mean age 62.5±6.1 years; 35.1% female), males demonstrated higher adverse outcome event rates than females (29.1% vs 21.3%) over median 11.6-year follow-up. Multivariate analyses revealed independent SDOH associations with adverse outcomes, with distinct sex-specific patterns. In male participants, low income (HR 1.30, 95% CI 1.08 to 1.55), unemployment (HR 1.28, 95% CI 1.06 to 1.55), living alone (HR 1.29, 95% CI 1.07 to 1.55) and housing insecurity (HR 1.26, 95% CI 1.01 to 1.57) were associated with adverse outcomes, while emotional distress was the only predictor (HR 1.33, 95% CI 1.04 to 1.69) in females.

conclusionsSDOH demonstrate sex-specific associations with adverse cardiovascular outcomes in AF populations. Integration of SDOH into risk prediction algorithms may enhance cardiovascular risk stratification and inform targeted intervention strategies in AF management.

Indexed as

Atrial FibrillationSocial Determinants of HealthAgedFemaleFollow-Up StudiesHealth Status DisparitiesHumansMaleMiddle AgedPrognosisRetrospective StudiesRisk AssessmentRisk FactorsSex FactorsUnited KingdomAtrial FibrillationEpidemiologyRISK FACTORSWomen

Identifiers

PMID41448845
PMCPMC12742081

What Socratic holds

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LicenceCC BY-NC
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.