Social Determinants of Cardiovascular Disease Risk Factors Among Black Ethnic Groups: Findings From the 2013 to 2018...

Social determinants of health (SDOH) affect cardiovascular disease (CVD) risk in Black adults, but there is limited knowledge on how SDOH dimensions are linked to CVD risk factors across different Black groups. The study examined differences in SDOH dimensions and CVD risk factors among Black ethnic groups, hypothesizing stronger associations for US-born adults.

Using the National Health Interview Surveys 2013 to 2018, we categorized 24 380 non-Hispanic Black adults by birthplace into 3 groups: US born, Caribbean born, and African born. Thirteen SDOH variables were reduced to 4 indices (standard of living, neighborhood cohesion, socioeconomic advantage, and health care access) using principal component analysis. Associations between these indices and the prevalence of 3 self-reported CVD risk factors (hypertension, diabetes, and high cholesterol) were assessed using modified Poisson regression models.

Among US-born Black adults, all SDOH indices were significantly associated with hypertension, diabetes, and high cholesterol (P<0.05), except for low standard of living and poor neighborhood cohesion with high cholesterol. For Caribbean-born Black adults, a low standard of living was associated with a higher prevalence of hypertension (prevalence ratio, 1.10 [95% CI, 1.1-1.21]) and diabetes (prevalence ratio, 1.24 [95% CI, 1.11-1.38]). Among African-born Black adults, only socioeconomic disadvantage was significantly associated with hypertension (prevalence ratio, 1.15 [95% CI, 1.05-1.26]).

The relationship between CVD risk factors and SDOH indices varied across different Black groups and was not consistent for all indices and risk factors. These distinct associations underscore the importance of tailored interventions to address context-specific CVD risk factors and social determinants to protect cardiovascular health.