Abstract P637: Sex-Specific Population Attributable Fractions to Cardiovascular Mortality Among US Adults

Abstract

Background: Previous studies suggest that prevalence and associations of metabolic risk factors with cardiovascular disease (CVD) differ between women and men. However, few studies have investigated the simultaneous contributions of social, behavioral, and metabolic risk factors to CVD mortality for women and men in a US nationally representative sample. Results of this study could aid researchers, clinicians, and policymakers in developing precision strategies to reduce the burden of CVD. Hypothesis: Metabolic risk factors contribute to CVD mortality more in men than women, and social determinants of health (SDOH) and behavioral risk factors contribute to CVD mortality more in women than men. Methods: We included 50,808 participants aged ≥20 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. Social determinants of health and behavioral and metabolic risk factors were collected in each survey cycle. CVD mortality was ascertained by ICD-10 codes I00-I09, I11, I13, I20-I51, and I60-I69. We estimated the simultaneous impact of social, behavioral, and metabolic risk factors on CVD mortality in women and men using average population attributable fractions, which consider both the prevalence and strength of association of all risk factors in one model. Results: During a median 9.0-year follow-up, 2,589 CVD deaths were recorded (1,140 in women; 1,449 in men). Current smoking, hypertension, diabetes, and albuminuria contributed to CVD mortality significantly among both women and men. SDOH, behavioral and metabolic risk factors contributed 11.2%, 9.0%, and 30.2% to CVD mortality among women, but 9.6%, 7.4%, and 33.9% among men (Table). Conclusions: Social and behavioral risk factors have a larger role in population-level CVD mortality among women, while metabolic factors play a larger role in men. However, overall population attributable fractions of CVD mortality were similar in women and men.