Unfavorable social determinants of health and mortality risk by cardiovascular disease status: Findings from a National Study of United States Adults - 07/12/23

Doi : 10.1016/j.ahj.2023.10.006

Muhammad Haisum Maqsood, MD, MS ^a, Ryan Nguyen, DO ^a, Ryan Chang, BS ^b, Harun Kundi, MD, MSc ^c, Kobina Hagan, MD, MPH ^a,^c, Sara Butt, MS ^c, Anoop Titus, MD ^d, Adnan A. Hyder, MD, PhD, MPH ^e, Umair Javed, MD ^f, Sadeer Al-Kindi, MD ^a,^d,ⁱ, Michael J. Blaha, MD ^g, Elias Mossialos, MD ^h, Khurram Nasir, MD, MSc ^a,^d,ⁱ, Zulqarnain Javed, MD, PhD ^a,^d,^i,^⁎
^a Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX
^b Baylor College of Medicine, Houston, TX
^c Center for Health Data Science and Analytics, Houston Methodist, Houston, TX
^d Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX
^e Center on Commercial Determinants of Health, Milken Institute School of Public Health, The George Washington University, Washington, DC
^f University of Health Sciences, CMH Medical Center, Lahore, Pakistan
^g Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Medicine
^h Department of Health Policy, London School of Economics, London, United Kingdom
ⁱ Center for Cardiovascular Computational Health & Precision Medicine (C3-PH), Houston Methodist, Houston, TX

^⁎Reprint requests: Zulqarnain Javed, MD, PhD, Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX 77030.Department of CardiologyHouston Methodist DeBakey Heart and Vascular CenterHoustonTX77030

ABSTRACT

Background

The association between cumulative burden of unfavorable social determinants of health (SDoH) and all-cause mortality has not been assessed by atherosclerotic cardiovascular disease (ASCVD) status on a population level in the United States.

Methods

We assessed the association between cumulative social disadvantage and all-cause mortality by ASCVD status in the National Health Interview Survey, linked to the National Death Index.

Results

In models adjusted for established clinical risk factors, individuals experiencing the highest level of social disadvantage (SDoH-Q4) had over 1.5 (aHR = 1.55; 95%CI = 1.22, 1.96) and 2-fold (aHR = 2.21; 95% CI = 1.91, 2.56) fold increased risk of mortality relative to those with the most favorable social profile (SDoH-Q1), respectively for adults with and without ASCVD; those experiencing co-occurring ASCVD and high social disadvantage had up to four-fold higher risk of mortality (aHR = 3.81; 95%CI = 3.36, 4.32).

Conclusions

These findings emphasize the importance of a healthcare model that prioritizes efforts to identify and address key social and environmental barriers to health and wellbeing, particularly in individuals experiencing the double jeopardy of clinical and social risk.

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Descriptive characteristics

Age-adjusted mortality rates

Multivariable analyses

Discussion

Health equity implications

Esportazione

Vol 267

P. 95-100 - Gennaio 2024 Ritorno al numero

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Unfavorable social determinants of health and mortality risk by cardiovascular disease status: Findings from a National Study of United States Adults - 07/12/23

ABSTRACT

Background

Methods

Results

Conclusions

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