Background Few studies have examined the prospective associations between socioeconomic measures and incident heart failure, and little is known about possible mechanisms underlying the relationship. The aim of this study was to investigate the association of socioeconomic measures with incident heart failure in older adults and to examine possible underlying pathways.

Methods A socially and geographically representative cohort of men aged 60–79 years in 1998–2000 from 24 British towns was followed-up for 10 years for incident heart failure (fatal and non-fatal based on death certificates and doctor-diagnosis). Adult socioeconomic measures included longest-held occupational social class, education, pension (state only or state with private), and amenities (car and house ownership, access to central heating) – a cumulative score of adverse socioeconomic measures from 0 to ≥ 4 was used. Childhood socioeconomic measures included father’s occupational social class, and household amenities. Prevalent myocardial infarction and heart failure cases were excluded.

Results Among 3839 men, 232 incident cases of heart failure occurred over 10 years. The hazard for heart failure was higher in the lowest occupational social classes; hazard ratio for social class IV & V (lowest social class) was 1.70 (95% CI 0.97, 2.96) compared to social class I (highest social class). Heart failure risk increased with increasing score of adverse adult socioeconomic measures (p for trend = 0.0006). Compared to men with a score of 0, the hazard ratio for men with a score of ≥4 was 2.17 (1.34, 3.53), which was attenuated to 1.85 (1.11, 3.08) after adjusting for systolic blood pressure, body mass index, smoking, HDL-cholesterol, diabetes and lung function. Adjustment for left ventricular hypertrophy, atrial fibrillation, heart rate and renal function made little difference. Further adjustment for C-reactive protein, von Willebrand Factor and plasma vitamin C slightly weakened the hazard ratio to 1.72 (1.01, 2.94). Risk of heart failure did not vary by childhood socioeconomic measures.

Conclusion Inequalities in heart failure in older populations need to be addressed – the risk of heart failure in older age was greater in the most deprived socioeconomic groups, which was only partly explained by established and novel risk factors for heart failure.