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Background Low socioeconomic status (SES) is linked to increased cardiovascular risk, but its association with carotid atherosclerosis in the general population is less well studied. We examined associations between individual-level and area-level SES and carotid plaque burden and explored potential sex differences.Methods In this cross-sectional analysis from the Akershus Cardiac Examination 1950 Study, individual-level SES was defined by educational attainment, and area-level SES by urban versus rural residence and median household income of municipality. Carotid ultrasound was used to quantify plaque burden with a plaque score (0–3 per segment; maximum 24), where >3 indicates elevated cardiovascular risk. Associations between SES and plaque score were estimated using Poisson regression in crude and adjusted models.Results We included 3673 participants (48.8% women; mean age 63.9 years). The prevalence of elevated plaque score (>3) was 23.3% in tertiary, 28.2% in secondary and 31.4% in primary education groups (p for trend <0.001). Women and men with primary education had 32% and 24% higher plaque scores than those with tertiary education (p<0.001). After adjustment for cardiovascular risk factors, excess atherosclerotic burden remained 22% in women and 12% in men (p<0.001). No significant associations were observed for area-level SES, and no sex interactions were detected.Conclusion Lower educational attainment is associated with higher carotid atherosclerotic burden in both sexes, independent of cardiovascular risk factors, while area-level SES shows no clear association. These findings suggest that educational disparities contribute to atherosclerotic disease burden and merit further investigation in longitudinal studies.