Abstract

BackgroundQuantifying the cumulative effect of social risk factors on cardiovascular disease (CVD) risk can help to better understand the sources of disparities in health outcomes.Method and resultsData from the Heart Strategies Concentrating on Risk Evaluation (HeartSCORE) study were used to create an index of cumulative social risk (CSR) and quantify its association with incident CVD and all-cause mortality. CSR was defined by assigning a score of 1 for the presence of each of 4 social factors: i) racial minority status (Black race), ii) single living status, iii) low income, and iv) low educational level. Hazard ratios (HRs) were computed using Cox-regression models, adjusted for CVD risk factors. Over a median follow-up period of 8.3 years, 127 incident events were observed. The incidence of the primary outcome for subgroups of participants with 0, 1, and ≥2 CSR scores was 5.31 (95% CI, 3.40–7.22), 10.32 (7.16–13.49) and 17.80 (12.94–22.67) per 1000 person-years, respectively. Individuals with CSR score of 1 had an adjusted HR of 1.85 (1.15–2.97) for incident primary outcomes, compared to those with score of 0. The corresponding HR for individuals with CSR score of 2 or more was 2.58 (1.60–4.17).ConclusionAn accumulation of social risk factors independently increased the likelihood of CVD events and deaths in a cohort of White and Black individuals.

Highlights

  • Quantifying the cumulative effect of social risk factors on cardiovascular disease (CVD) risk can help to better understand the sources of disparities in health outcomes

  • Diastolic blood pressure and Body mass index (BMI), as well as highsensitivity C-reactive protein (hsCRP) and IL6 concentrations increased across categories of cumulative social risk (CSR)

  • The CSR index was univariately associated with a broad spectrum of CVD risk factors

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Summary

Introduction

Quantifying the cumulative effect of social risk factors on cardiovascular disease (CVD) risk can help to better understand the sources of disparities in health outcomes. Racial disparities in cardiovascular disease (CVD) risk and mortality is an important challenge for health care in the United States and worldwide [1,2,3,4]. Few studies to date have investigated the cumulative effect of multiple social risk factors on CVD risk [7, 8]. A recent study of NHANES III data reported the cumulative effect of four social risk factors (i.e., belonging to an ethnic minority group, low income, low education, single living status) on risk of CVD mortality and all-cause mortality [7]. Each additional social risk score was found to be associated with a 17% higher risk of CVD mortality and 43% higher risk of under 65-year old mortality [7]

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