Self-reported Social Determinants Of Health Research Articles

Social Determinants of Health Phenotypes and Cardiometabolic Condition Prevalence Among Patients in a Large Academic Health System: Latent Class Analysis.

Adverse social determinants of health (SDoH) have been associated with cardiometabolic disease; however, disparities in cardiometabolic outcomes are rarely the result of a single risk factor. This study aimed to identify and characterize SDoH phenotypes based on patient-reported and neighborhood-level data from the institutional electronic medical record and evaluate the prevalence of diabetes, obesity, and other cardiometabolic diseases by phenotype status. Patient-reported SDoH were collected (January to December 2020) and neighborhood-level social vulnerability, neighborhood socioeconomic status, and rurality were linked via census tract to geocoded patient addresses. Diabetes status was coded in the electronic medical record using International Classification of Diseases codes; obesity was defined using measured BMI ≥30 kg/m2. Latent class analysis was used to identify clusters of SDoH (eg, phenotypes); we then examined differences in the prevalence of cardiometabolic conditions based on phenotype status using prevalence ratios (PRs). Complete data were available for analysis for 2380 patients (mean age 53, SD 16 years; n=1405, 59% female; n=1198, 50% non-White). Roughly 8% (n=179) reported housing insecurity, 30% (n=710) reported resource needs (food, health care, or utilities), and 49% (n=1158) lived in a high-vulnerability census tract. We identified 3 patient SDoH phenotypes: (1) high social risk, defined largely by self-reported SDoH (n=217, 9%); (2) adverse neighborhood SDoH (n=1353, 56%), defined largely by adverse neighborhood-level measures; and (3) low social risk (n=810, 34%), defined as low individual- and neighborhood-level risks. Patients with an adverse neighborhood SDoH phenotype had higher prevalence of diagnosed type 2 diabetes (PR 1.19, 95% CI 1.06-1.33), hypertension (PR 1.14, 95% CI 1.02-1.27), peripheral vascular disease (PR 1.46, 95% CI 1.09-1.97), and heart failure (PR 1.46, 95% CI 1.20-1.79). Patients with the adverse neighborhood SDoH phenotype had higher prevalence of poor cardiometabolic conditions compared to phenotypes determined by individual-level characteristics, suggesting that neighborhood environment plays a role, even if individual measures of socioeconomic status are not suboptimal.

Model-based estimation of individual-level social determinants of health and its applications in All of Us.

We introduce a widely applicable model-based approach for estimating individual-level Social Determinants of Health (SDoH) and evaluate its effectiveness using the All of Us Research Program. Our approach utilizes aggregated SDoH datasets to estimate individual-level SDoH, demonstrated with examples of no high school diploma (NOHSDP) and no health insurance (UNINSUR) variables. Models are estimated using American Community Survey data and applied to derive individual-level estimates for All of Us participants. We assess concordance between model-based SDoH estimates and self-reported SDoHs in All of Usand examine associations with undiagnosed hypertension and diabetes. Compared to self-reported SDoHs, the area under the curve for NOHSDP is 0.727 (95% CI, 0.724-0.730) and for UNINSUR is 0.730 (95% CI, 0.727-0.733) among the 329074 All of Us participants, both significantly higher than aggregated SDoHs. The association between model-based NOHSDP and undiagnosed hypertension is concordant with those estimated using self-reported NOHSDP, with a correlation coefficient of 0.649. Similarly, the association between model-based NOHSDP and undiagnosed diabetes is concordant with those estimated using self-reported NOHSDP, with a correlation coefficient of 0.900. The model-based SDoH estimation method offers a scalable and easily standardized approach for estimating individual-level SDoHs. Using the All of Us dataset, we demonstrate reasonable concordance between model-based SDoH estimates and self-reported SDoHs, along with consistent associations with health outcomes. Our findings also underscore the critical role of geographic contexts in SDoH estimation and in evaluating the association between SDoHs and health outcomes.

The impact of self-reported social determinants of health (SDOH) on patient engagement and symptom burden across a remote patient monitoring (RPM) pathway in 42 European hospitals.

1506 Background: SDOH are a significant driver of cancer care disparities impacting access to care, adherence to treatment plans, treatment-related toxicities and quality of life (QoL) across the cancer care continuum. RPM based on electronic patient-reported outcomes (ePROs) is a powerful tool to facilitate communication between pts and providers, thereby improving symptom management, QoL and disease outcomes. Equitable participation in RPM pathways must be ensured to avoid increase existing disparities. In this study we report the prevalence of unfavorable SDOH and their impact on engagement with RPM and symptom burden in an RPM pathway deployed in routine care across 42 hospitals in FR and BE. Methods: Patient-level SDOH data provided by consented pts enrolled in the RPM pathway between 08-2023 and 12-2023 was used. Single-item questions were dichotomized from validated ePROs covering educational level, health literacy (3 subdomains health status, treatment and disease understanding), digital literacy, employment status, financial and food security, caregiver support, and access to care. SDOH profiles were defined as unfavorable (impairment at moderate/elevated level) vs. favorable (absence or impairment at a low level). RPM engagement and symptom burden were defined respectively as weekly ePRO reporting and number of alerts due to severe or worsening symptoms. Multivariable backward stepwise regression models (including age, gender, stage, health behaviors) assessed associations between SDOH profile and RPM engagement and symptom burden. Results: 896 (40%) pts provided SDOH data, of which 622 (69%) females with median age of 60 (P25-75 50-70). Most common primary tumor were breast (436, 49%) and gastrointestinal (171, 19%), 488 (55%) were non-metastatic. 653 (73%) pts reported at least 1 unfavorable SDOH, specifically: 199 (22.2%) on educational level, 134 (15.0%) on health status understanding, 27 (3.0%) on treatment understanding, 84 (9.4%) on disease understanding, 218 (24.3%) on digital literacy, 63 (7.0%) on employment status, 104 (11.6%) on financial security, 89 (9.9%) on food security, 348 (38.8%) on caregiver support and 56 (6.3%) on access to care. Lower RPM engagement was associated with unfavorable digital literacy (β -0.05, p<0.001) and treatment understanding (β -0.1, p=0.004). Higher symptom burden was associated with unfavorable financial security (β 0.066, p=0.020) and disease understanding (β -0.1077, p=0.001), but favorable employment status (β 0.0497, p=0.025). Conclusions: RPM with ePROs offers an opportunity to screen for SDOH in routine care. The vast majority of pts enrolled had at least 1 unfavorable SDOH. Specific actionable unfavorable SDOH were associated with lower engagement and higher symptom burden. Personalizing RPM pathways according to SDOH may foster equitable care.

Self-Reported Social Determinants of Health and Area-Level Social Vulnerability

Many health care systems are investing resources in identifying social determinants of health (SDoH) needs and facilitating interventions among the populations they serve. Because self-reported SDoH information is lacking, area-level measures are often used to estimate needs and direct resources. To describe the large-scale deployment of SDoH assessments by a health system and determine the extent to which self-reported SDoH needs identified therein are associated with census tract-level social vulnerability measured using the Social Vulnerability Index (SVI). This cross-sectional study assessed SDoH needs between January 1, 2020, and April 30, 2023, in both payer and clinical care settings. Modalities included telephonic outreach, face-to-face clinical interactions, self-entry into a tablet or kiosk, and web-based survey tools. Participants included individuals who responded to the assessment and had sufficient information for census tract identification. Respondents included both Highmark Health Plan members and nonmembers. Health plan members responded to the assessment through health plan programs or platforms, and both members and nonmembers responded to assessments during inpatient or outpatient encounters with the affiliated health system. Overall and domain-specific SDoH needs self-reported through assessments, and severity and complexity of needs identified. Residential social vulnerability measures included overall SVI and the 4 conceptual themes comprising overall SVI. In total, 841 874 assessments were recorded for 401 697 individuals (55.1% women; median [IQR] age, 55 [41-70] years). Social determinants of health needs were identified in 120 769 assessments (14.3%). Across all SDoH domains, increasing SVI was associated with a higher positivity rate (eg, 11.2% of those residing in the lowest-risk SVI quintile reported a need compared with 22.7% among those residing in the highest-risk quintile). Associations varied by SDoH domain and SVI theme. After adjusting for demographic and screening characteristics, odds of positive screening among those residing in the highest-risk SVI quintile were 1.74 (95% CI, 1.62-1.86) to 3.73 (95% CI, 3.48-4.00) times the odds among those residing in lowest risk quintile. In this cross-sectional study, the overall level of SDoH needs generally corresponded to area-level vulnerability. Some SDoH domains appeared far more sensitive to community characteristics than others. Notably, even among individuals from the highest-risk areas, the positive screening rate was roughly 1 in 4. These findings underscore the importance of individual-level SDoH data for service provision planning and health services research.

Cumulative inequality in social determinants of health in relation to depression symptom: An analysis of nationwide cross-sectional data from U.S. NHANES 2005–2018

Social determinants of health (SDoH) have been linked to a higher likelihood of experiencing mental health problems. This study aimed to investigate whether the accumulation of unfavorable SDoH is associated with depression symptom. Data was gathered from a representative population participating in the U.S. National Health and Nutrition Examination Survey spanning from 2005 to 2018. Self-reported SDoH were operationalized according to the criteria outlined in Healthy People 2030, with a cumulative measure of unfavorable SDoH calculated for analysis. The presence of depression symptom was identified using the Patient Health Questionnaire in a representative sample of 30,762 participants (49.2 % males) representing 1,392 million non-institutionalized U.S. adults, with 2,675 (8.7 %) participants showing depression symptom. Unfavorable SDoH were found to be significantly and independently associated with depression symptom. Individuals facing multiple unfavorable SDoHs were more likely to experience depression symptom (P for trend < 0.001). For instance, a positive association was observed in participants exposed to six or more unfavorable SDoHs with depression symptom (AOR = 3.537, 95 % CI: 1.781, 7.075, P-value < 0.001). The findings emphasize that the likelihood of developing depression symptom significantly increases when multiple SDoHs are present, compared to just a single SDoH.

Contribution of individual and cumulative social determinants of health underlying gender disparities in periodontitis in a representative US population: A cross-sectional NHANES study.

To examine the impact of both individual and cumulative social determinants of health (SDoH) on the likelihood of developing periodontitis, while also exploring any gender disparities in this relationship. Data of self-reported SDoH domains and sub-items based on Healthy People 2030 were obtained from the U.S. National Health and Nutrition Examination Surveys between 1999 and 2014. Logistic regression models, weighted by survey responses, were used to examine the relationship between SDoH (including eight sub-items and the cumulative number of unfavourable SDoH) and periodontitis. The results were further analysed by gender. A total of 18,075 participants (8867 males and 9208 females) were included in the main analysis, of which 5814 (32.2%) had periodontitis. The study found that certain unfavourable SDoH were individually associated with higher odds of periodontitis, and the cumulative number of unfavourable SDoH was positively linked to the odds of developing periodontitis. Furthermore, males exposed to more unfavourable SDoH appeared to be more susceptible to developing periodontitis than females. The findings suggest that unfavourable SDoH, especially when they accumulate, are associated with an increased odds of periodontitis and contribute to gender disparities within the U.S.

Orthopaedic Sports Medicine Randomized Controlled Trials Infrequently Report on the Social Determinants of Health Factors of Their Patient Cohorts

To describe the prevalence of randomized controlled trials (RCTs) in orthopaedic sports medicine-related journals reporting on the social determinants of health (SDOH) of their patient cohorts, including factors receiving less attention, such as education level, employment status, insurance status, and socioeconomic status. The PubMed/MEDLINE database was used to search for RCTs between 2020 and 2022 from 3 high-impact orthopaedic sports medicine-related journals: American Journal of Sports Medicine, Arthroscopy, and Journal of Shoulder and Elbow Surgery. The following information was extracted from each article: age, sex/gender, body mass index, year published, corresponding author country, and self-reported SDOH factors (race, ethnicity, education level, employment status, insurance status, and socioeconomic status). A total of 189 articles were analyzed. Articles originated from 34 different countries, with the United States (n= 66) producing the greatest number of articles. Overall, age (n= 186; 98.4%) and sex/gender (n=184; 97.4%) were the factors most commonly reported, followed by body mass index (n= 112; 59.3%), race (n= 17; 9.0%), ethnicity (n= 10; 5.3%), employment status (n= 9; 4.8%), insurance status (n= 7; 3.7%), and education level (n= 5; 2.6%). Socioeconomic status was not reported in any of the articles analyzed. Articles from the United States report on SDOH factors more frequently than international articles, most notably race (24.2% vs 0.8%, respectively) and ethnicity (15.2% and 0%, respectively). RCTs from 3 high-impact orthopaedic sports medicine journals infrequently report on SDOH. Better understanding patient SDOH factors in RCTs is important to help orthopaedic surgeons and other practitioners best apply study results to their patients, as well as help researchers and our field ensure that research is being done transparently with relevance to as many patients as possible.

Social determinants of health and premature death among adults in the USA from 1999 to 2018: a national cohort study

Racial and ethnic disparities in mortality persist in the US population. We studied the contribution of social determinants of health (SDoH) to racial and ethnic disparities in premature death. A nationally representative sample of individuals aged 20-74 years who participated in the US National Health and Nutrition Examination Survey (NHANES) between 1999 and 2018 were included. Self-reported SDoH (employment, family income, food security, education, access to health care, health insurance, housing instability, and being married or living with a partner) were collected in each survey cycle. Participants were categorised into four groups of race and ethnicity: Black, Hispanic, White, and other. Deaths were ascertained from linkage to the National Death Index with follow-up until 2019. Multiple mediation analysis was used to assess simultaneous contributions of each individual SDoH to racial disparities in premature all-cause mortality. We included 48 170 NHANES participants in our analyses, consisting of 10 543 (21·9%) Black participants, 13 211 (27·4%) Hispanic participants, 19 629 (40·7%) White participants, and 4787 (9·9%) participants of other racial and ethnic groups. Mean survey-weighted age was 44·3 years (95% CI 44·0-44·6), 51·3% (50·9-51·8) of participants were women, and 48·7% (48·2-49·1) were men. 3194 deaths before age 75 years were recorded (930 Black participants, 662 Hispanic participants, 1453 White participants, and 149 other participants). Black adults had significantly higher premature mortality than other racial and ethnic groups (p<0·0001): premature death rates per 100 000 person-years were 852 (95% CI 727-1000) for Black adults, 445 (349-574) for Hispanic adults, 546 (474-630) for White adults, and 521 (336-821) for other adults. Unemployment, lower family income, food insecurity, less than high school education, no private health insurance, and not being married nor living with a partner were significantly and independently associated with premature death. Dose-response associations were observed between cumulative number of unfavourable SDoH and premature all-cause mortality: hazard ratios (HRs) were 1·93 (95% CI 1·61-2·31) for those with one unfavourable SDoH, 2·24 (1·87-2·68) for those with two, 3·98 (3·34-4·73) for those with three, 4·78 (3·98-5·74) for those with four, 6·08 (5·06-7·31) for those with five, and 7·82 (6·60-9·26) for those with six or more unfavourable SDoH (p<0·0001 for linear trend). After adjusting for SDoH, HRs for premature all-cause mortality for Black adults compared with White adults decreased from 1·59 (1·44-1·76) to 1·00 (0·91-1·10), suggesting complete mediation of this racial difference in mortality. Unfavourable SDoH are associated with increased rates of premature death and contribute to differences between Black and White racial groups in premature all-cause mortality in the US population. Innovative public health policies and interventions targeting SDoH are needed to reduce premature deaths and health disparities in this population. US National Institutes of Health.

Pharmacist Preceptor Exposure, Comfort and Awareness of Resources to Address the Social Determinants of Health-A Pilot Study.

As preceptors are responsible for the experiential education of future pharmacists, it is important to assess understanding and identify knowledge gaps for preceptor development. The purpose of this pilot study was to assess the exposure to social determinants of health (SDOH), comfort in addressing social needs, and awareness of social resources among the preceptors at one college of pharmacy. A brief online survey was sent to all affiliated pharmacist preceptors with screening criteria for pharmacists who had regular one-on-one patient interactions. Of 166 preceptor respondents (response rate = 30.5%), 72 eligible preceptors completed the survey. Self-reported SDOH exposure increased along the educational continuum (with increasingly more emphasis from the didactic to experiential to residency). Preceptors who graduated after 2016, practiced in either community or clinic settings and served >50% of underserved patients were the most comfortable addressing social needs and the most aware of social resources. Preceptor understanding of SDOH has implications for their ability to educate future pharmacists. Colleges of pharmacy should evaluate practice site placement as well as preceptor knowledge and comfort in addressing social needs in order to ensure that all students are exposed to the SDOH throughout the continuum of learning. Best practices for up-skilling preceptors in this area should also be explored.

Abstract MP06: Impact Of Social Determinants Of Health On Optimal Cardiovascular Health Among Asian American Subgroups

Background: Limited disaggregated Asian subgroup data exists on the impact of social determinants of health (SDOH) on optimal cardiovascular (CV) health. Hypothesis: Compared to non-Hispanic whites (NHW), Asian subgroups have a greater likelihood of optimal CV health, but this observation may be attenuated after controlling for SDOH. Methods: We analyzed results from the National Health Interview Survey (2013-2018), a nationally representative sample. Self-reported SDOH variables include demographics, food security, healthcare access, financial security, and neighborhood cohesion. We conducted stepwise, multivariable logistic regression, analyzing the association between race/ethnicity and CV risk profile score iteratively controlling for SDOH, based on the presence of CV risk factors (RF): diabetes mellitus, hypertension, obesity, smoking, insufficient physical activity, and high cholesterol. CV risk profile sum was categorized as optimal (0-1 RF) or sub-optimal (≥ 2 RF). Results: Our study sample included 112,380 individuals [mean age 49.1 (SD 18.6)]: 92.7% NHW, 1.6% Asian Indian, 1.5% Chinese, 1.6% Filipino, and 2.6% other Asian. The final model, adjusted for all domains of SDOH, showed that odds for optimal CV health for Filipinos compared to NHW were not significant (OR= 1.06, 95% CI: 0.90, 1.24, p = 0.47). After adjusting for all SDOH, Chinese had the highest odds of optimal CV health compared to NHWs (OR=2.47, 95% CI: 2.08, 2.94, p &lt; 0.001), while the greatest change was observed for Asian Indians [Model 1: OR 1.94 (95% CI 1.7, 2.22) versus Model 5: OR 1.7 (95% CI 1.47, 1.96)]. Conclusion: Asian Indian, Chinese, and other Asian subgroups had a higher likelihood of optimal CV health compared to NHWs after controlling for SDOH but no significant differences were observed for Filipinos. This association was modestly attenuated only for Asian Indians after controlling for all SDOH. Future research should focus on the modifying effects that race/ethnicity may have on the association between SDOH and optimal CV health.

Social Determinants of Health Influence Early Outcomes Following Lumbar Spine Surgery.

Background: Disparities among social determinants of health (SDoH) can impact overall well-being and surgical outcomes. The purpose of this study was to identify SDoH for patients who underwent lumbar spine surgery and evaluate their relationship to the postoperative outcomes of length of stay (LOS), discharge disposition, and readmissions. Methods: We conducted a retrospective observational study of patients who underwent lumbar spine surgery from July 2017 to January 2021. We used a self-reported SDoH survey in conjunction with the electronic medical record to gather patient information. Multivariate analysis was used to evaluate the relationships between patient demographics, SDoH, and postoperative outcomes. Results: A total of 951 patients underwent lumbar spine surgery: 484 (50.9%) had decompressive laminectomy alone without fusion, and 467 (49.1%) had decompressive laminectomy with instrumented posterolateral fusion. When controlling for age, American Society of Anesthesiologists physical status classification, and surgery type, the SDoH of being currently married or having a life partner was associated with shorter LOS and decreased likelihood of discharge to a skilled nursing facility. Financial strain was associated with longer LOS, while attending church was associated with a decreased likelihood of 30-day emergency department (ED) return. Conclusion: This study identified various SDoH that may influence postoperative lumbar spine surgery outcomes of LOS, discharge disposition, 30-day ED return, and 30-day readmission. Patients at risk for suboptimal outcomes appear to be those with lower financial resources, less in-home support, and lower social connectivity. Routine screening of SDoH may enable care teams to effectively allocate resources for at-risk patients.

Experiencing Bullying Is Associated With Firearm Access, Weapon Carriage, Depression, Marijuana Use, and Justice Involvement in Adolescents.

The aims of this study were to assess whether bullying experience among youths is associated with firearm access and to evaluate assault perpetration risk factors between bullied and nonbullied adolescents. This was a secondary analysis of a cross-sectional survey designed to measure self-reported social determinants of health and behavioral health risks among adolescents (13-21 years) in a pediatric emergency department between July 2017 and August 2019. Participants were included in this subanalysis if they responded to a survey item that assessed bullying. Multivariable logistic regression was used to measure the association of firearm access, weapon carriage, and assault perpetration factors (violence, mental health, substance abuse, and justice involvement) with bullying after adjustment for sex, race/ethnicity, and insurance status. Of the 369 participants meeting inclusion criteria, 147 adolescents (40.5%) reported experiencing bullying. Bullied teenagers had higher odds of a gun in the home (adjusted odds ratio [aOR], 3.0; 95% confidence interval [CI], 1.2-7.8]), weapon carriage (aOR, 5.6; 95% CI, 1.6-18.8), witnessing an assault (aOR, 3.0; 95% CI, 1.6-5.6), negative experience with law enforcement (aOR, 4.5; 95% CI, 2.2-9.2), mental health diagnosis (aOR, 3.9; 95% CI, 2.3-6.7), and marijuana use (aOR, 2.7; 95% CI, 1.1-7.0]). More than 1 in 3 adolescents presenting to the emergency department report having ever experienced bullying. Bullied teenagers have a higher likelihood of firearm access, weapon carriage, and violent injury perpetration risk factors compared with nonbullied youths. Further studies are needed to understand the relationship between bullying and assault perpetration.

Relative Importance of Self-Reported Social Determinants of Health for Risk of Depression

Prior research demonstrates univariate relationships between social determinants of health (SDoH) and depression, but less is known about the relative importance (RI) of SDoH variables when considered simultaneously, allowing for interactions. We aimed to identify the most influential SDoH for depression in a cohort of older adults.

Social Determinants of Health Mediate COVID-19 Disparities in South Florida.

BackgroundThere are several reports of health disparities related to COVID-19. Understanding social determinants of health (SDoH) could help develop mitigation strategies to prevent further COVID-19 spread. Our aim is to evaluate self-reported and census-based SDoH as a mediator of health disparities in COVID-19.MethodsWe conducted a cross-sectional ecological study and included all COVID-19 cases report by the COVID-19 Florida dashboard as the dependent variable. The independent variables were census-based median household income, population and household size, and self-reported SDoH using a validated survey. We calculated the incidence rate ratio (IRR) of COVID-19 by zip code using Poisson regression and structured equation modelling to evaluate the mediation effect of income and SDoH on COVID-19 cases.ResultsWe included 97,594 COVID-19 positive cases across 79 Miami-Dade ZIP codes with a median age of 43 years; females represented 50.7% of the cases. The highest IRR (4.44) were for ZIP code 33125 (income $21,106, 6% Black, 93% Hispanic), while the lowest IRR (0.86) was for ZIP code 33146 (median household incomes $96,609, 3% Black and 53% Hispanic). In structured equation models, the indirect coefficient of income in the relationship between race/ethnicity and COVID-19 were only significant for Blacks and not Hispanics.ConclusionsThis ecological analysis using ZIP code and aggregate individual-level SDoH shows that in Miami-Dade county, COVID infection is associated with economic disadvantage in a particular geographical area and not with racial/ethnic distribution.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-020-06341-9.

Social determinants of health score: does it help identify those at higher cardiovascular risk?

Cardiovascular disease (CVD) continues to disproportionately affect disadvantaged populations, leading to calls to address social determinants of health (SDOH) as a preventive strategy. Our aim is to create a weighed SDOH score and to test the impact of each SDOH factor on the Framingham risk score (FRS) and on individual traditional CVD risk factors. We conducted a retrospective cohort study. We included patients seen at a primary care clinic at UHealth/University of Miami Health System who answered a SDOH survey between September 16, 2016, and September 10, 2017. The survey included SDOH domains recommended by the American Heart Association position statement and by the National Academy of Medicine. We selected the FRS as well as all traditional CVD risk factors as our outcome metrics. We included 2876 patients. The mean (SD) age of our cohort was 53.8 (15.8) years, 61% were female, 9% were Black, 38% were Hispanic, and 87% reported speaking English. The statistically significant β coefficients in the FRS model corresponded to being born outside of the United States, being a racial minority, living alone, having a high social isolation score, and having a low geocoded median household income (P < .01). Increasing quartile of SDOH score was significantly associated with higher systolic blood pressure, FRS, glycated hemoglobin, and smoking pack-years (P < .05). It was also associated with fewer minutes spent exercising weekly (P < .01). The addition of self-reported SDOH data has a dose effect on CVD risk factors. Future studies should address how to intervene to address social factors.