DOI: 10.1161/circ.148.suppl_1.12346 ISSN: 0009-7322

Abstract 12346: Atherosclerotic Cardiovascular Disease Risk Associated With Social Determinants of Health at Individual and Area Levels

Mengying Xia, Jaejin An, Monika M Safford, Lisandro Colantonio, Paul Muntner, Kristi Reynolds, Andrew E Moran, Yiyi Zhang
  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Introduction: Adverse social determinants of health (SDOH) are associated with an increased risk for atherosclerotic cardiovascular disease (ASCVD). However, it is unclear if the ASCVD risks associated with area-level SDOH are similar to those with individual-level measures. Further, SDOH are not included in the Pooled Cohort Equations (PCEs) when estimating 10-year ASCVD risk. Studies have shown that PCEs systematically underestimate risk for socially deprived individuals.

Aims To examine the association of individual- and area-level SDOH including education, income, and employment with incident ASCVD. Also, we assessed if adding SDOH to the PCEs improves risk prediction accuracy.

Methods: We pooled data from four cohorts: Jackson Heart Study, Multi-Ethnic Study of Atherosclerosis, Framingham Heart Study Offspring Cohort, and Reasons for Geographic and Racial Differences in Stroke Study. We excluded participants with a history of ASCVD. Individual-level SDOH were based on participants’ self-report and area-level SDOH were derived by linking participants’ addresses to US Census tract data. We used Cox proportional hazards models to assess the associations between SDOH and ASCVD. We also assessed the changes in discrimination (Harrell’s C-index) and calibration (Integrated Brier Score) after adding SDOH to risk prediction models.

Results: We analyzed data from 27,603 participants (mean age 61.4 years, 59% women, and 49% White). During a median follow-up of 13 years, 2,839 incident ASCVD events occurred. Both individual- and area-level SDOH were associated with ASCVD ( Figure, Panel A ). Adding both individual- and area-level SDOH to risk prediction modestly improved model discrimination and calibration in Black men and women ( Figure, Panels B & C ), and also improved calibration in non-Black women.

Conclusions: The findings suggest that SDOH may be considered in the development of future ASCVD risk assessment tools, particularly among Black individuals.

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