Neighborhood Income and Atherosclerotic Burden on Coronary CT Angiography.

BACKGROUND: Socioeconomic disparities influence cardiovascular outcomes, yet their relationship with imaging-defined coronary atherosclerosis on coronary CT angiography (CCTA) is not fully understood. We evaluated whether neighborhood-level income and other sociodemographic factors independently predict atherosclerotic burden in a contemporary CCTA population. METHODS: We conducted a retrospective cross-sectional analysis of adults aged 40-79 years undergoing CCTA at a tertiary academic center from 2015 to 2024. Primary outcomes were coronary artery calcium and obstructive coronary artery disease, defined as Coronary Artery Disease-Reporting and Data System (CAD-RADS ≥3). A secondary comparator was 10-year Atherosclerotic Cardiovascular Disease (ASCVD) risk category. Primary exposures included census tract-level median household income and race/ethnicity. Ordinal and logistic regression models were sequentially adjusted for demographic, socioeconomic, and clinical risk factors. RESULTS: Among 1,171 participants, lower household income was independently associated with higher ASCVD risk category and greater imaging-defined atherosclerotic burden. Compared with individuals residing in census tracts with median income ≥$150,000, those in areas with income <$50,000 had approximately twofold higher odds of obstructive coronary artery disease after full adjustment. Associations between race/ethnicity and imaging outcomes were substantially attenuated after adjustment for income and clinical risk factors, although residual associations persisted for ASCVD risk category. CONCLUSIONS: Neighborhood socioeconomic context is independently associated with imaging-defined atherosclerotic burden on coronary CT angiography. Incorporation of socioeconomic indicators may improve cardiovascular risk assessment beyond traditional clinical risk factors.