Disparities in tobacco smoking and risk of cardiovascular disease in people with low socioeconomic status or serious psychological distress: A simulation analysis

Introduction: High tobacco smoking prevalence in people with low SES or serious psychological distress (SPD) in the U.S. may increase cardiovascular disease (CVD) risk among these marginalized subpopulations. We estimate how smoking disparities contribute to CVD disparities.

Methods: Using the Simulation of Tobacco and Nicotine Outcomes and Policy model, a validated microsimulation model of tobacco use and clinical outcomes, we used 2004-2019 data from the National Health Interview Survey to first compare 20-year cumulative CVD incidence for 40-year-olds by sex, smoking status, and marginalized subpopulation membership. Second, we simulated the marginalized subpopulations with representative age, sex, and smoking status distributions to estimate 20-year cumulative CVD incidence under status quo and counterfactual scenarios. In the counterfactual scenario, smoking prevalence and trends in the low SES and SPD subpopulations match those in the higher SES and non-SPD subpopulations, respectively.

Results: The model-projected impact of smoking on 20-year cumulative CVD incidence is considerably larger than the impact of low SES or SPD; for example, among 40-year-old males, cumulative CVD incidence is 28.3% for low SES people who currently smoke, 13.0% for low SES people who never smoke, and 26.2% for higher SES people who currently smoke. In the second analysis, in the status quo scenario, model-projected 20-year cumulative CVD incidence is 19.3% for low SES and 22.1% for SPD; in the counterfactual scenario, it is 18.1% for low SES and 19.6% for SPD.

Conclusions: Interventions focused on reducing smoking disparities could substantially reduce CVD in marginalized subpopulations.