Abstract 02: Contributions of Social Determinants of Health to Premature Cardiovascular Mortality in the US General Population

Abstract

Introduction: Quantifying the contributions of 8 social determinants of health (SDOH) to US population-level premature cardiovascular disease (CVD) mortality will aid in developing and implementing strategies to reduce the burden of CVD mortality for diverse populations. Hypothesis: Levels of unfavorable SDOH are more common in Black and Hispanic adults in the US and contribute to a higher proportion of US population-level premature CVD mortality compared with White adults. Methods: We included 48170 participants aged 20-74 years from the National Health and Nutrition Examination Survey 1999-2018, linked to the National Death Index for cause-specific mortality follow-up through December 31, 2019. Premature CVD mortality was defined as death before age 75 with underlying ICD-10 codes for heart disease or stroke. SDOH included employment, family income-poverty ratio, food security, education, healthcare access, insurance status, home ownership, and marital status. We estimated average population attributable fractions to quantify the contribution of each SDOH to premature CVD mortality by self-reported race/ethnicity. Models controlled for age, sex, and survey year. Results: Combined SDOH accounted for >50% of US population-level premature CVD mortality among US adults (Figure). Among Black adults, SDOH accounted for 64.2% of premature CVD mortality, which was larger than that for Hispanic (58.4%) and White (55.0%) adults. Unemployment was generally the SDOH most strongly associated with premature CVD mortality, with PAFs (95% confidence intervals) ranging from 14.7% (7.3-22.0%) among White adults to 20.8% (7.7-33.9%) among Black adults. Low family income-poverty ratio contributed an additional 27.3% of premature CVD mortality in Black adults. Conclusion: SDOH account for >50% of premature CVD deaths in US adults but contributions differ by race/ethnicity. Interventions targeting SDOH may simultaneously reduce premature CVD mortality among all adults while addressing associated disparities.