DOI: 10.1161/jaha.125.048128 ISSN: 2047-9980

Correlation of the Distressed Communities Index Score With Cardiovascular Risk Factors and Disease in the United States

Zachary Meili, Shady Abohashem, Keith C. Ferdinand, Jared Magnani, Laurence Sperling, Estefania Oliveros, Sarju Ganatra, Michael W. Daniels, Salim S. Virani, Dinesh K. Kalra
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Background

Cardiovascular disease (CVD) remains the leading cause of morbidity and death worldwide. Risk scores such as the pooled cohort equations often underpredict risk in individuals with low socioeconomic status.

Methods

We used the Centers for Disease Control and Prevention Population Level Analysis and Community Estimates data set to obtain zip code–level prevalence of hypertension, obesity, stroke, diabetes, and coronary artery disease. The Distressed Communities Index (DCI) collates community socioeconomic status and social determinants/drivers of health metrics into a numerical score. Linear regression adjusted for region and rurality assessed associations between DCI and CVD prevalence.

Results

We included 26 058 US zip codes (2016–2020). The median DCI was 50.9 (interquartile range, 25.4–75.9). Each 1‐unit increase in DCI was associated with increased prevalence of obesity (β=0.10 [95% CI, 0.09–0.10]), hypertension (β=0.08 [95% CI, 0.08–0.09]), diabetes (β=0.06 [95% CI, 0.06–0.06]), coronary artery disease (β=0.03 [95% CI, 0.03–0.03]), and stroke (β=0.02 [95% CI, 0.02–0.02]; all P <0.001). Rurality and region were independently associated with CVD and risk factor prevalence, with rural and southern zip codes having the highest prevalence.

Conclusions

DCI, geographic region, and rurality are independently associated with greater prevalence of CVD and its risk factors in the United States. The DCI is a practical, scalable surrogate for socioeconomic status and social determinants/drivers of health that may enhance CVD risk stratification on the basis of an area's economic resilience or disadvantage. Using DCI with the Preventing Cardiovascular Events score may capture economic and social challenges it omits, warranting further study.

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