Prevailing income-based disparities in cardiovascular events in young hospitalized adults with cannabis use disorder: insights from a population-based analysis.

Mohammed A.; Ahmed H.; Manne S.; Yasmeen U.; Devarala B.; Amreen J.; Vanukuru S.; Suchday P.; Begum I.; Polamarasetty H. et al. · BMC public health · 2026

**Background & Methods** This retrospective cross-sectional study analyzed young adult hospitalizations (18-44 years) with cannabis use disorder (CUD) from the 2020 National Inpatient Sample, comparing cardiovascular outcomes between high-income quartile (HIQ) and low-income quartile (LIQ) cohorts using propensity score-matched analysis (1:1 matching) on 286,855 recreational cannabis users. **Key Findings** • Low-income CUD patients demonstrated significantly higher prevalence of cardiovascular risk factors compared to high-income counterparts, including hypertension (17% vs. 14.7%), diabetes (8% vs. 6.6%), chronic pulmonary disease (13.2% vs. 12.7%), tobacco use (24.9% vs. 22.6%), and obesity (10.9% vs. 10.0%). • In-hospital major adverse cardiac and cerebrovascular events (MACCE) were substantially elevated in the LIQ cohort (2% vs. 0.8%), with acute ischemic stroke (AIS) rates nearly double in low-income patients (0.5% vs. 0.3%). • After adjusting for confounding variables, high-income CUD patients had 37% lower risk of AIS-related admissions compared to low-income patients (OR: 0.63 [95% CI: 0.42-0.96], p<0.05). **Dosage & Administration** Not reported. **Safety & Adverse Effects** Not reported. The study focuses on cardiovascular complications and adverse outcomes rather than direct cannabis-related adverse effects. **Evidence Quality** This study has notable limitations affecting evidence quality. As a retrospective cross-sectional analysis, it cannot establish causality between income status, cannabis use, and cardiovascular outcomes. The reliance on administrative coding data (National Inpatient Sample) introduces potential miscoding and incomplete capture of variables. The predominance of white participants (>65%) and geographic concentration in the South limits generalizability to diverse populations. Propensity score matching addresses some confounding but cannot account for unmeasured confounders such as medication adherence, healthcare access patterns, or detailed substance use characteristics. The study represents hospitalized populations only, excluding outpatient cases and varying disease severity. While findings suggest socioeconomic disparities in cardiovascular outcomes among CUD patients, the evidence quality is moderate, warranting confirmation through prospective, longitudinal studies with more comprehensive data collection across diverse demographic groups.

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