News Release

Low household income can increase risk of death after heart surgery

Swedish study examines income, death association in population with universal health care

Peer-Reviewed Publication

American College of Cardiology

Low household income was associated with higher risk of death after cardiac surgery in Sweden despite that the entire population has access to free health care, according to a study published online today in the Journal of the American College of Cardiology.

The association between low socioeconomic status and a higher risk of heart disease and death is well-known. However, most studies are conducted in populations without universal health care coverage, where socioeconomic status can determine access to health care.

Researchers in this study looked at patients in Sweden who had cardiac surgery over a 14-year span. All patients had access to the same health care plan and hospital quality under the country's universal health care plan. All cardiac surgeries in Sweden are performed at a small number of centers with similar standards of care and performance.

According to the researchers, the association between low income and death remained the same despite other socioeconomic status variables, comorbidities and cardiovascular risk factors. The study shows that the impact of socioeconomic status on death cannot be explained by disparities in health care alone and ways to better implement secondary prevention measures for low-income patients should be explored.

Limitations of the study include that registry data used did not include information on lifestyle factors such as smoking habits, job strain, diet, level of physical activity and compliance with medication. Also, there was no data on medication or health care during the follow-up period.


The American College of Cardiology is a 49,000-member medical society that is the professional home for the entire cardiovascular care team. The mission of the College is to transform cardiovascular care and to improve heart health. The ACC leads in the formation of health policy, standards and guidelines. The College operates national registries to measure and improve care, provides professional medical education, disseminates cardiovascular research and bestows credentials upon cardiovascular specialists who meet stringent qualifications. For more information, visit

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