A Novel Cumulative Social Advantage Metric for Enhancing the Cardiovascular Health Construct and Predicting Mortality...

Area of Science:

• Public Health and Epidemiology
• Social Determinants of Health Research
• Cardiovascular Health Outcomes

Background:

• Cardiovascular health (CVH) is influenced by social determinants of health (SDoH).
• Current guidelines like Life's Essential 8 (LE8) do not incorporate SDoH metrics.
• A need exists for measurable SDoH metrics to assess their impact on CVH.

Purpose of the Study:

• To evaluate a Social Advantage Metric (SAM) for its association with mortality.
• To determine if incorporating SAM as a ninth metric enhances CVH score predictive value.
• To analyze SAM's predictive power across different demographic groups.

Main Methods:

• Utilized data from 46,366 US adults (1999-2018 National Health and Nutrition Examination Survey).
• Developed a multidimensional SAM score based on nine SDoH indicators.
• Employed multivariable Cox proportional hazards models to assess mortality risk and predictive performance of CVH scores with and without SAM.

Main Results:

• Higher SAM scores were significantly associated with lower all-cause and cardiovascular mortality risk (p-trend<0.001).
• An enhanced CVH score including SAM demonstrated comparable predictive performance to the LE8 score alone (C-statistic=0.835 vs. 0.831).
• Associations between SAM and mortality varied by race and ethnicity, with significant prediction observed in White and Black adults.

Conclusions:

• An enhanced CVH score incorporating a Social Advantage Metric (SAM) effectively predicts mortality in US adults.
• Social determinants of health, measured by SAM, are crucial for understanding cardiovascular health outcomes.
• Further research is needed to explore social advantage and resilience factors, especially among Hispanic adults.