Disclosures: Nasir reports serving on advisory boards for Amgen, Novartis and The Medicines Company. Please see the study for all other authors’ relevant financial disclosures.
October 18, 2021
2 min read

Premature CVD death more frequent in ‘socially vulnerable’ counties

Disclosures: Nasir reports serving on advisory boards for Amgen, Novartis and The Medicines Company. Please see the study for all other authors’ relevant financial disclosures.
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CVD death in people younger than 65 years was elevated in U.S. counties with a high social vulnerability index, according to new data published in Circulation.

Khurram Nasir

“There is compelling research suggesting that social factors — apart from medical conditions — play a more important role in health than previously thought,” Khurram Nasir, MD, MPH, MSc, chief of cardiovascular prevention and wellness at Houston Methodist DeBakey Heart and Vascular Center and co-director of the Center for Outcomes Research at Houston Methodist, said in a press release. “Emerging studies suggest that conditions in the places where people live, learn, work and play — called social determinants of health — contribute to higher risk of premature death for people living in socially vulnerable communities.”

Graphical depiction of data presented in article.
Data were derived from Khan SU, et al. Circulation. 2021;doi:10.1161/CIRCULATIONAHA.121.054516.

Social factors and premature CVD death

Nasir and colleagues conducted a cross-sectional study linking county-level CDC/Agency for Toxic Substances and Disease Registry Social Vulnerability Index data from 2014 to 2018 with county-level mortality data from the CDC WONDER database. The social vulnerability index included 15 factors — below poverty, unemployed, low income, no high school diploma, age 65 years or older, age 17 years or younger, age 5 years or older with a disability, single-parent household, minority status, speaking English “less than well,” multi-unit housing structure, mobile home, crowding, no vehicle and group quarters — grouped into four themes: socioeconomic status, household composition/disability, minority status/language and housing type/transportation.

Counties were stratified into quartiles based on social vulnerability index score. The researchers analyzed each quartile by age-adjusted mortality rates per 100,000 person-years for CVD and its subtypes for adults younger than 65 years.

The overall age-adjusted premature CVD mortality rate per 100,000 person-years was 47. The counties with the highest social vulnerability index scores and the highest age-adjusted premature CVD mortality rates were concentrated in the southwestern and southeastern regions of the U.S., according to the researchers.

Compared with counties in the lowest quartile of social vulnerability index, counties in the highest quartile had higher premature mortality for CVD (RR = 1.84; 95% CI, 1.43-2.36), ischemic heart disease (RR = 1.52; 95% CI, 1.09-2.13), stroke (RR = 2.03; 95% CI, 1.12-3.7), hypertension (RR = 2.71; 95% CI, 1.54-4.75) and HF (RR = 3.38; 95% CI, 1.32-8.61), Nasir and colleagues wrote.

The risks varied by demographics, such as Black adults in the highest quartile having much higher risk for premature death from stroke or HF compared with Black adults in the lowest quartile and rural counties in the highest quartile having twofold to fivefold excess premature mortality risks compared with those in the lowest quartile, the researchers wrote.

‘Urgent need’

“There is an urgent need for everyone to realize the importance of these social risks and their potential impact on health, as well as for health systems and doctors to ensure that we incorporate these assessments into our routine care,” Nasir said in the release. “This will allow us to develop more tailored interventions, such as supporting cost-related barriers via community resources, addressing transportation barriers and other relevant social risks can be developed. As the link between social risk and health outcomes is more clearly defined and detailed, future policy and practice models should ensure appropriate resources are allocated to address excessive risk in socially vulnerable communities.”