Education and Household Income Are Associated with Incident Venous Thromboembolism: The Atherosclerosis Risk In Communities Study

Introduction: Venous thromboembolism (VTE) is associated with morbidity and mortality. Emerging evidence suggests that social factors may influence VTE risk through pathways like behavior, stress, and comorbidities, offering opportunities for improved prevention and risk stratification beyond established predictors. Hypotheses: Lower educational attainment and household income are associated with increased risk of VTE. Methods: The Atherosclerosis Risk In Communities (ARIC) study enrolled 15,792 individuals in 1987-89. Participants reported household income (<$12,000, $12,000-$24,999, $25,000-$49,999, or > $50,000) and educational attainment (<high school, high school graduate, or ≥college). We identified and adjudicated incident VTE events through 2019. Using ARIC visit 4 (1996-1998) as our baseline visit, we examined the association of household income and level of education attainment with the risk of VTE using Cox proportional hazards models. We excluded participants with a history of VTE, use of anticoagulation, or missing covariates. Results: Following exclusions, we included 8,116 ARIC participants (age 62.8 + 5.7 years, 48.4% female, 19.0% self-identified as Black race). In total, 9.7% had household income <$12,000 and 17.5% education <high school. There were 599 VTE events over a mean follow-up of 17.3 + 6.2 years. Individuals with <high school education had 1.3-fold (95% CI, 1.02-1.63) higher VTE risk compared to those with college education after adjusting for age, sex, race, and race*center (Figure, panels A, C). Likewise, individuals in the lowest household income had 1.4-fold (95% CI, 1.03-1.93) higher VTE risk compared to those in the highest income category (Figure, panels B, D). Educational attainment and household income were not associated with VTE following additional multivariable adjustment. Conclusions: We observed that educational attainment and income were associated with increased VTE risk. These results underscore the importance of integrating social factors into VTE risk assessment.