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

Muhammad Haisum Maqsood, Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX.
Ryan Nguyen, Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX.
Ryan Chang, Baylor College of Medicine, Houston, TX.
Harun Kundi, Center for Health Data Science and Analytics, Houston Methodist, Houston, TX.
Kobina Hagan, Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX; Center for Health Data Science and Analytics, Houston Methodist, Houston, TX.
Sara Butt, Center for Health Data Science and Analytics, Houston Methodist, Houston, TX.
Anoop Titus, Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX.
Adnan A. Hyder, Center on Commercial Determinants of Health, Milken Institute School of Public Health, The George Washington University, Washington, DC.
Umair Javed, University of Health Sciences, CMH Medical Center, Lahore, Pakistan.
Sadeer Al-Kindi, Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX; Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX; Center for Cardiovascular Computational Health & Precision Medicine (C3-PH), Houston Methodist, Houston, TX.
Michael J. Blaha, Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Medicine.
Elias Mossialos, Department of Health Policy, London School of Economics, London, United Kingdom.
Khurram Nasir, Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX; Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX; Center for Cardiovascular Computational Health & Precision Medicine (C3-PH), Houston Methodist, Houston, TX.
Zulqarnain Javed, Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX; Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX; Center for Cardiovascular Computational Health & Precision Medicine (C3-PH), Houston Methodist, Houston, TX. Electronic address: zjaved@houstonmethodist.org.

Document Type

Journal Article

Publication Date

1-1-2024

Journal

American heart journal

Volume

267

DOI

10.1016/j.ahj.2023.10.006

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.

Department

Global Health

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