Socioeconomic status, healthcare access, and risk of atrial fibrillation: an investigation using the Jackson Heart Study Research Materials

Background: Rates of atrial fibrillation (AF) are lower in Black compared to White Americans. Socioeconomic disadvantage and reduced healthcare access may contribute to lower observed AF incidence in Black populations due to underdiagnosis and underascertainment. Therefore, we evaluated the association of socioeconomic status and healthcare access with AF incidence in a cohort of Black Americans. Methods: 3,240 participants from the Jackson Heart Study, which recruited Black adults from the Jackson metropolitan area in 2000-2004, were followed up through 2016 for incident AF. Socioeconomic position (education and income) and healthcare access (insurance status, difficulty obtaining care, trust in providers, and satisfaction with care) were assessed at baseline. AF was ascertained from study electrocardiograms at baseline and exam 3 and self-reported physician diagnosis at annual follow-up surveys. Multivariable Cox regression was used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association between exposure variables and AF incidence adjusting for potential confounders. Results: During a mean follow-up of 11.5 years, 817 incident AF cases were identified. Higher educational attainment and income were associated with a reduced risk of AF. Compared with participants who had less than a high school education, those who attended trade or vocational school or college had an 18% lower estimated hazard of AF (HR 0.82, 95% CI 0.67, 1.02). Likewise, participants in the highest income category had a 39% lower estimated hazard of AF (HR 0.61, 95% CI 0.47, 0.78) compared with those in the lowest. Easier access to healthcare and greater satisfaction with received healthcare were also associated with lower AF risk. Conclusion: Higher socioeconomic status and better healthcare access were associated with lower risk of AF in a cohort of Black Americans. These findings do not support a simple explanation in which socioeconomic disadvantage and poorer healthcare access lead to lower observed AF incidence through underascertainment within Black adults.