Association Between Social Vulnerability Index and Cardiovascular Disease: A Behavioral Risk Factor Surveillance System Study

• Type of Material: Article
• Authors: Vardhmaan Jain, Emory University; Mahmoud Al Rifai, Baylor College of Medicine; Safi U Khan, Houston Methodist DeBakey Heart & Vasc Ctr; Ankur Kalra, Indiana University School of Medicine; Fatima Rodriguez, Stanford University; Zainab Samad, Aga Khan University; Yashashwi Pokharel, Wake Forest Baptist Health; Arunima Misra, Baylor College of Medicine; Laurence Sperling, Emory University; Jamal S Rana, Kaiser Permanente Oakland Medical Center; Waqas Ullah, Thomas Jefferson University Hospital; Ankit Medhekar, Baylor College of Medicine; Salim S Virani, Baylor College of Medicine
• Language: English
• Date: 2022-08-02
• Publisher: WILEY
• Publication Version: Final Published Version
• Copyright Statement: © 2022 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1161/JAHA.121.024414
• Title of Journal or Parent Work: JOURNAL OF THE AMERICAN HEART ASSOCIATION
• Volume: 11
• Issue: 15
• Start Page: e024414
• End Page: e024414
• Grant/Funding Information: This study received funding from makeadent.org and the Ram and Sanjita Kalra Aavishqaar Fund.
• Keywords: Cardiovascular System & Cardiology; Cardiac & Cardiovascular Systems; risk factors; cardiovascular disease; INDICATORS; social vulnerability; CORONARY-HEART-DISEASE; SVI; Science & Technology; NATIONAL-HEALTH; HEALTH INTERVIEW SURVEY; Life Sciences & Biomedicine
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

BACKGROUND: Social and environmental factors play an important role in the rising health care burden of cardiovascular dis-ease. The Centers for Disease Control and Prevention developed the Social Vulnerability Index (SVI) from US census data as a tool for public health officials to identify communities in need of support in the setting of a hazardous event. SVI (ranging from a least vulnerable score of 0 to a most vulnerable score of 1) ranks communities on 15 social factors including unemploy-ment, minoritized groups status, and disability, and groups them under 4 broad themes: socioeconomic status, housing and transportation, minoritized groups, and household composition. We sought to assess the association of SVI with self-reported prevalent cardiovascular comorbidities and atherosclerotic cardiovascular disease (ASCVD). METHODS AND RESULTS: We performed a retrospective cohort analysis of adults (≥18 years) in the Behavioral Risk Factor Surveillance System 2016 to 2019. Data regarding self-reported prevalent cardiovascular comorbidities (including diabetes, hypertension, hyperlipidemia, smoking, substance use), and ASCVD was captured using participants’ response to a struc-tured telephonic interview. We divided states on the basis of the tertile of SVI (first—participant lives in the least vulnerable group of states, 0– 0.32; to third—participant lives in the most vulnerable group of states, 0.54–1.0). Multivariable logistic regression models adjusting for age, race and ethnicity, sex, employment, income, health care coverage, and association with federal poverty line were constructed to assess the association of SVI with cardiovascular comorbidities. Our study sample consisted of 1 745 999 participants ≥18 years of age. States in the highest (third) tertile of social vulnerability had predominantly Black and Hispanic adults, lower levels of education, lower income, higher rates of unemployment, and higher rates of prevalent comorbidities including hypertension, diabetes, chronic kidney disease, hyperlipidemia, substance use, and ASCVD. In multivariable logistic regression models, individuals living in states in the third tertile of SVI had higher odds of having hypertension (odds ratio (OR), 1.14 [95% CI, 1.11–1.17]), diabetes (OR, 1.12 [95% CI, 1.09–1.15]), hyperlipidemia (OR, 1.09 [95% CI, 1.06–1.12]), chronic kidney disease (OR, 1.17 [95% CI, 1.12–1.23]), smoking (OR, 1.05 [95% CI, 1.03–1.07]), and ASCVD (OR, 1.15 [95% CI, 1.12–1.19]), compared with those living in the first tertile of SVI. CONCLUSIONS: SVI varies across the US states and is associated with prevalent cardiovascular comorbidities and ASCVD, independent of age, race and ethnicity, sex, employment, income, and health care coverage. SVI may be a useful assessment tool for health policy makers and health systems researchers examining multilevel influences on cardiovascular-related health behaviors and identifying communities for targeted interventions pertaining to social determinants of health.