{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T11:38:41Z","timestamp":1781350721017,"version":"3.54.1"},"reference-count":49,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T00:00:00Z","timestamp":1766534400000},"content-version":"unspecified","delay-in-days":176,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institute of Health Research","doi-asserted-by":"crossref","award":["PJT-178237"],"award-info":[{"award-number":["PJT-178237"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2025,12,1]]},"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Despite anticoagulation, patients with atrial fibrillation (AF) experience persistent elevated cardiovascular risk, with conflicting evidence regarding sex-based outcome disparities. Social determinants of health (SDOH)\u2014encompassing economic, psychosocial and environmental factors\u2014demonstrate 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 3842 participants (mean age 62.5\u00b16.1 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%\u2009CI 1.08 to 1.55), unemployment (HR 1.28, 95%\u2009CI 1.06 to 1.55), living alone (HR 1.29, 95%\u2009CI 1.07 to 1.55) and housing insecurity (HR 1.26, 95%\u2009CI 1.01 to 1.57) were associated with adverse outcomes, while emotional distress was the only predictor (HR 1.33, 95%\u2009CI 1.04 to 1.69) in females.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>SDOH 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/openhrt-2025-003732","type":"journal-article","created":{"date-parts":[[2025,12,25]],"date-time":"2025-12-25T12:45:11Z","timestamp":1766666711000},"page":"e003732","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Sex differences in the association of social determinants of health and adverse cardiovascular outcomes in patients with atrial fibrillation"],"prefix":"10.1136","volume":"12","author":[{"given":"Yusheng","family":"Zhou","sequence":"first","affiliation":[{"name":"Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada"},{"name":"Department of Medicine, McGill University, Montreal, 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