Impact of socioeconomic factors on cardiovascular diseases, diabetes and all-cause mortality in patients with uveitis: a Danish cohort study

PURPOSE: Uveitis is a group of intraocular inflammatory conditions that may result in severe visual impairment. The potential interplay between uveitis and socioeconomic factors remains largely unexplored. This study investigated the association between socioeconomic factors and the risk of cardiovascular disease, diabetes and all-cause mortality in patients with uveitis.

DESIGN: Nationwide cohort study.

METHODS: All patients registered with a uveitis diagnosis at a Danish public hospital between 2000 and 2018 were included and stratified into low, intermediate or high educational or household income level. Data from different registers were linked using a personal identification number. Using the high levels as the reference, we estimated incidence rates and cumulative incidence. We quantified the differences using HRs with 95% CIs for cardiovascular disease, diabetes and all-cause mortality through Cox proportional hazards models.

RESULTS: In a cohort of 18 225 patients with uveitis, we observed increased rates and risks of all-cause mortality, peripheral artery disease, myocardial infarction, heart failure, ischaemic heart disease, stroke, and diabetes for lower educational or income level. The following HRs (95% CI) were elevated in patients with uveitis with low or intermediate socioeconomic status: all-cause mortality (low status: education: 1.58 (1.30 to 1.90); income: 2.09 (1.70 to 2.59); intermediate status: income: 1.56 (1.25 to 1.94)), diabetes (low status: education: 1.72 (1.33 to 2.23); income: 2.15 (1.65 to 2.79)), peripheral artery disease (low status: education 2.87 (1.77 to 4.68); intermediate status: income: 2.11 (1.35 to 3.30)), myocardial infarction (low status: education: 2.13 (1.32 to 3.44); intermediate status: income: 2.29 (1.40 to 3.75)), heart failure (low status: education: 1.99 (1.33 to 2.96); income: 2.05 (1.35 to 3.11)), ischaemic heart disease (low status: education: 1.62 (1.24 to 2.11)), and stroke (low status: income: 1.70 (1.19 to 2.43)).

CONCLUSION: Patients with uveitis with lower educational or income level faced a statistically significantly increased risk of cardiovascular disease, diabetes and mortality. Alongside the direct burden of uveitis, socioeconomic status should also be accounted for when assessing patient risk and designing management strategies.