Association Between Social Vulnerability Index and Cardiovascular Disease: A Behavioral Risk Factor Surveillance System Study

Journal of the American Heart Association - Tập 11 Số 15 - 2022
Vardhmaan Jain1, Mahmoud Al Rifai2, Safi U. Khan3, Ankur Kalra4, Fátima Rodríguez5, Zainab Samad6, Yashashwi Pokharel7, Arunima Misra8, Laurence S. Sperling9, Jamal S. Rana10, Waqas Ullah11, Ankit Medhekar12, Salim S. Virani13,14,15
1Vardhmaan Jain https://orcid.org/0000-0001-7265-380X , Department of Internal Medicine, , Cleveland Clinic Foundation, , Cleveland, , OH,
2Mahmoud Al Rifai https://orcid.org/0000-0002-6933-790X , Section of Cardiology and Cardiovascular Research, Department of Medicine, , Baylor College of Medicine, , Houston, , TX,
3Safi U. Khan https://orcid.org/0000-0003-1559-6911 , Department of Cardiology, , Houston Methodist DeBakey Heart & Vascular Center, , Houston, , TX,
4Ankur Kalra https://orcid.org/0000-0003-0080-1660 , Division of Cardiovascular Medicine, Krannert Cardiovascular Research Center, , Indiana University School of Medicine, , Indianapolis, , IN,
5Fatima Rodriguez https://orcid.org/0000-0002-5226-0723 , Division of Cardiovascular Medicine and the Cardiovascular Institute, , Stanford University School of Medicine, , Stanford, , CA,
6Zainab Samad , Department of Cardiovascular Medicine, , Aga Khan University, , Karachi, , Pakistan,
7Section of Cardiovascular Medicine, Department of Medicine Wake Forest Baptist Health Winston‐Salem NC
8Arunima Misra , Section of Cardiology and Cardiovascular Research, Department of Medicine, , Baylor College of Medicine, , Houston, , TX,
9Laurence S. Sperling https://orcid.org/0000-0001-9417-6370 , Division of Cardiovascular Medicine, , Emory University School of Medicine, , Atlanta, , GA,
10Jamal S. Rana , Division of Cardiovascular Medicine, , Kaiser Permanente Oakland Medical Center, , Oakland, , CA,
11Waqas Ullah https://orcid.org/0000-0002-4850-0309 , Division of Cardiovascular Medicine, , Thomas Jefferson University Hospital, , Philadelphia, , PA,
12Ankit Medhekar https://orcid.org/0000-0002-4682-3526 , Section of Cardiology and Cardiovascular Research, Department of Medicine, , Baylor College of Medicine, , Houston, , TX,
13Section of Cardiology and Cardiovascular Research, Department of Medicine Baylor College of Medicine Houston TX
14Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX
15Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX

Tóm tắt

Background Social and environmental factors play an important role in the rising health care burden of cardiovascular disease. The Centers for Disease Control and Prevention developed the Social Vulnerability Index (SVI) from US census data as a tool for public health officials to identify communities in need of support in the setting of a hazardous event. SVI (ranging from a least vulnerable score of 0 to a most vulnerable score of 1) ranks communities on 15 social factors including unemployment, minoritized groups status, and disability, and groups them under 4 broad themes: socioeconomic status, housing and transportation, minoritized groups, and household composition. We sought to assess the association of SVI with self‐reported prevalent cardiovascular comorbidities and atherosclerotic cardiovascular disease (ASCVD).

Methods and Results We performed a retrospective cohort analysis of adults (≥18 years) in the Behavioral Risk Factor Surveillance System 2016 to 2019. Data regarding self‐reported prevalent cardiovascular comorbidities (including diabetes, hypertension, hyperlipidemia, smoking, substance use), and ASCVD was captured using participants' response to a structured telephonic interview. We divided states on the basis of the tertile of SVI (first—participant lives in the least vulnerable group of states, 0–0.32; to third—participant lives in the most vulnerable group of states, 0.54–1.0). Multivariable logistic regression models adjusting for age, race and ethnicity, sex, employment, income, health care coverage, and association with federal poverty line were constructed to assess the association of SVI with cardiovascular comorbidities. Our study sample consisted of 1 745 999 participants ≥18 years of age. States in the highest (third) tertile of social vulnerability had predominantly Black and Hispanic adults, lower levels of education, lower income, higher rates of unemployment, and higher rates of prevalent comorbidities including hypertension, diabetes, chronic kidney disease, hyperlipidemia, substance use, and ASCVD. In multivariable logistic regression models, individuals living in states in the third tertile of SVI had higher odds of having hypertension (odds ratio (OR), 1.14 [95% CI, 1.11–1.17]), diabetes (OR, 1.12 [95% CI, 1.09–1.15]), hyperlipidemia (OR, 1.09 [95% CI, 1.06–1.12]), chronic kidney disease (OR, 1.17 [95% CI, 1.12–1.23]), smoking (OR, 1.05 [95% CI, 1.03–1.07]), and ASCVD (OR, 1.15 [95% CI, 1.12–1.19]), compared with those living in the first tertile of SVI.

Conclusions SVI varies across the US states and is associated with prevalent cardiovascular comorbidities and ASCVD, independent of age, race and ethnicity, sex, employment, income, and health care coverage. SVI may be a useful assessment tool for health policy makers and health systems researchers examining multilevel influences on cardiovascular‐related health behaviors and identifying communities for targeted interventions pertaining to social determinants of health.

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Journal of the American Heart Association

Tập 11 Số 15

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