Abstract MP05: Proportion of All-Cause and Cardiovascular Disease Mortality Attributable to Social, Behavioral, and Metabolic Risk Factors in US Adults

Abstract

Introduction: Recent studies have shown that social determinants of health (SDoH) are related to all-cause and cardiovascular (CVD) mortality. However, the attribution of SDoH to all-cause and CVD mortality beyond behavioral and metabolic risk factors has not been quantified in the US general population. Methods: National Health and Nutrition Examination Survey (NHANES) 2005-2018 included a nationally representative sample of 25,165 individuals aged 20-74. Data on social, behavioral, and metabolic risk factors were collected using standard methods. Deaths were ascertained from linkage to the National Death Index with follow-up through 2019. Multivariable-adjusted Cox regression models using backwards elimination were used to select risk factors associated with all-cause and CVD mortality. Average population attributable fractions (PAF) for risk factors significantly associated with mortality were calculated. Results: Over an average of 7.6 years of follow-up, 765 CVD deaths and 2,540 all-cause deaths were confirmed. Hazard ratios and PAFs from multivariable-adjusted regression models are presented in the table. Overall, social, behavioral, and metabolic risk factors accounted for 71.1% (95% CI: 63.0, 79.3) of all-cause deaths and 70.6% (62.4, 78.7) of CVD deaths in the US population. The top five leading risk factors for all-cause mortality are hypertension (15.7%), physical inactivity (11.9%), lower family income (11.6%), not married or living with a partner (9.7%), and diabetes (7.0%); and for CVD mortality are hypertension (15.5%), lower family income (13.0%), physical inactivity (12.6%), not married or living with a partner (10.5%), and diabetes (7.1%). Conclusion: These data indicate that social, behavioral, and metabolic factors account for most all-cause and CVD deaths in the US. Furthermore, in addition to interventions targeting hypertension, diabetes, and physical activity, novel public health policies focusing on SDoH are warranted to reduce premature deaths in the US.