Social vulnerability profiles and heart disease and stroke in older adults from the EPIPorto cohort

Population ageing is increasing the number of people living with heart disease and stroke (HDS), with a disproportionate burden on disadvantaged groups. The multidimensional construct of social vulnerability plays a key role in HDS, yet the nature of this relation may be complex and non-linear.

This cross-sectional study examines how different components of social vulnerability cluster together and associate with HDS. We analysed data from 466 older adults from the EPIPorto cohort evaluated in 2017 and 2022. Social vulnerability was computed through seven variables: stressful life events, perceived social support (family, friends, significant other) and leisure activities in 2017; loneliness and housing problems in 2022. HDS was self-reported and collected at both moments. Model-based cluster analysis was used to identify distinct social vulnerability profiles. Odds ratios (ORs) with 95% confidence intervals (95% CIs) were computed using logistic regression models, adjusted for biological, educational and health-related confounders. History of HDS in 2017 or 2022 was present in 137 (29.4%) participants, who were older, more frequently widowed, and more often presented multimorbidity. Three clusters were identified: higher social vulnerability (n = 164, 37.3%), presenting the most social vulnerability adverse profile (reference category); average social vulnerability (n = 220, 50.0%), and lower social vulnerability (n = 56, 12.7%). The highest prevalence of HDS was observed in the higher cluster (37,2%), followed by the Lower cluster (30.4%). Individuals in the average cluster, when compared with the higher category, had significantly lower odds of reporting HDS independently of any confounder (OR = 0.47; 95% CI: 0.29–0.76). Individuals with higher social vulnerability exhibit a greater risk for HDS, but this relation was non-linear. These findings underscore the importance of integrating multiple social indicators into cardiovascular risk assessment in older adults.

Key messages

• HDS disproportionately affects disadvantaged groups. This study identifies distinct social vulnerability profiles among older adults and examines how they associate with HDS.

• More socially vulnerable individuals had a higher probability of HDS, but the relationship was not linear. Multiple social vulnerability domains should integrate CVD risk assessment in older adults.