Associations Between Health-Related Social Needs and Cardiovascular Health Among US Adults

Overview

Journal J Am Heart Assoc

Specialty Cardiology & Vascular Diseases

Date 2024 Nov 22

PMID 39575749

Authors

Zefeng Zhang

Sandra L Jackson

Angela M Thompson-Paul

Xiaoping Yin

Robert K Merritt

Fatima Coronado

Affiliations

Soon will be listed here.

Abstract

Background: Unfavorable health-related social needs (HRSNs) have the potential to worsen health and well-being and drive health disparities. Its associations with cardiovascular health (CVH), assessed by Life's Essential 8, have not been comprehensively examined among US adults.

Methods And Results: We used the National Health and Nutrition Examination Survey 2011 to March 2020 data for adults aged ≥20 years. We grouped Life's Essential 8 scores as low (0-49), moderate (50-79), and high (80-100) CVH. We identified 8 unfavorable HRSNs and assigned a value of 1 for the unfavorable status of each. The number of unfavorable HRSNs was summed and ranged from 0 to 8, with higher numbers indicating more unfavorable HRSNs. We used multivariable linear and multinomial logistic regression to examine the association between HRSNs and CVH. A total of 14 947 participants were included (n=7340 male [49.3%]; mean [SE] age, 46.4 [0.35] years). A higher number of unfavorable HRSNs were associated with worse CVH: comparing adults with unfavorable HRSNs of 1-2, 3-4, and ≥5 to those with none, the fully adjusted prevalence ratios (95% CI) for low CVH were 1.42 (1.17-1.73), 2.11 (1.69-2.63), and 2.42 (1.90-3.08), respectively. The corresponding prevalence ratios (95% CI) for high CVH were 0.77 (0.68-0.87), 0.58 (0.49-0.67), and 0.46 (0.38-0.55). The associations were consistent across subgroups and in sensitivity analyses.

Conclusions: There was a graded association between unfavorable HRSNs and a higher prevalence of low CVH or lower prevalence of high CVH. Public health interventions targeting HRSNs might reduce health disparities and promote CVH.

References

Williams A, Nolan T, Brock G, Garner J, Brewer L, Sanchez E . Association of Socioeconomic Status With Life's Essential 8 Varies by Race and Ethnicity. J Am Heart Assoc. 2023; 12(18):e029254. PMC: 10547287. DOI: 10.1161/JAHA.122.029254. View

He J, Bundy J, Geng S, Tian L, He H, Li X . Social, Behavioral, and Metabolic Risk Factors and Racial Disparities in Cardiovascular Disease Mortality in U.S. Adults : An Observational Study. Ann Intern Med. 2023; 176(9):1200-1208. PMC: 11149775. DOI: 10.7326/M23-0507. View

Tamura K, Langerman S, Ceasar J, Andrews M, Agrawal M, Powell-Wiley T . Neighborhood Social Environment and Cardiovascular Disease Risk. Curr Cardiovasc Risk Rep. 2019; 13(4). PMC: 6720128. DOI: 10.1007/s12170-019-0601-5. View

Lloyd-Jones D, Hong Y, Labarthe D, Mozaffarian D, Appel L, Van Horn L . Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association's strategic Impact Goal through 2020 and beyond. Circulation. 2010; 121(4):586-613. DOI: 10.1161/CIRCULATIONAHA.109.192703. View

Zhang Z, Jackson S, Merritt R, Gillespie C, Yang Q . Association between cardiovascular health metrics and depression among U.S. adults: National Health and Nutrition Examination Survey, 2007-2014. Ann Epidemiol. 2019; 31:49-56.e2. PMC: 10083895. DOI: 10.1016/j.annepidem.2018.12.005. View

Stamler J, STAMLER R, Neaton J, Wentworth D, Daviglus M, Garside D . Low risk-factor profile and long-term cardiovascular and noncardiovascular mortality and life expectancy: findings for 5 large cohorts of young adult and middle-aged men and women. JAMA. 1999; 282(21):2012-8. DOI: 10.1001/jama.282.21.2012. View

Zagozdzon P, Parszuto J, Wrotkowska M, Dydjow-Bendek D . Effect of unemployment on cardiovascular risk factors and mental health. Occup Med (Lond). 2014; 64(6):436-41. DOI: 10.1093/occmed/kqu044. View

Bundy J, Ning H, Zhong V, Paluch A, Lloyd-Jones D, Wilkins J . Cardiovascular Health Score and Lifetime Risk of Cardiovascular Disease: The Cardiovascular Lifetime Risk Pooling Project. Circ Cardiovasc Qual Outcomes. 2020; 13(7):e006450. PMC: 7772276. DOI: 10.1161/CIRCOUTCOMES.119.006450. View

Leung C, Tester J, Laraia B . Household Food Insecurity and Ideal Cardiovascular Health Factors in US Adults. JAMA Intern Med. 2017; 177(5):730-732. PMC: 5540641. DOI: 10.1001/jamainternmed.2017.0239. View

10.

Bieler G, Brown G, Williams R, Brogan D . Estimating model-adjusted risks, risk differences, and risk ratios from complex survey data. Am J Epidemiol. 2010; 171(5):618-23. DOI: 10.1093/aje/kwp440. View

11.

Minhas A, Jain V, Li M, Ariss R, Fudim M, Michos E . Family income and cardiovascular disease risk in American adults. Sci Rep. 2023; 13(1):279. PMC: 9822929. DOI: 10.1038/s41598-023-27474-x. View

12.

Knifton L, Inglis G . Poverty and mental health: policy, practice and research implications. BJPsych Bull. 2020; 44(5):193-196. PMC: 7525587. DOI: 10.1192/bjb.2020.78. View

13.

Ziso D, Chun O, Puglisi M . Increasing Access to Healthy Foods through Improving Food Environment: A Review of Mixed Methods Intervention Studies with Residents of Low-Income Communities. Nutrients. 2022; 14(11). PMC: 9182982. DOI: 10.3390/nu14112278. View

14.

Dhindsa D, Khambhati J, Schultz W, Tahhan A, Quyyumi A . Marital status and outcomes in patients with cardiovascular disease. Trends Cardiovasc Med. 2019; 30(4):215-220. DOI: 10.1016/j.tcm.2019.05.012. View

15.

Hozawa A, Folsom A, Sharrett A, Chambless L . Absolute and attributable risks of cardiovascular disease incidence in relation to optimal and borderline risk factors: comparison of African American with white subjects--Atherosclerosis Risk in Communities Study. Arch Intern Med. 2007; 167(6):573-9. DOI: 10.1001/archinte.167.6.573. View

16.

Polonsky T, Ning H, Daviglus M, Liu K, Burke G, Cushman M . Association of Cardiovascular Health With Subclinical Disease and Incident Events: The Multi-Ethnic Study of Atherosclerosis. J Am Heart Assoc. 2017; 6(3). PMC: 5524019. DOI: 10.1161/JAHA.116.004894. View

17.

Giannelis A, Palmos A, Hagenaars S, Breen G, Lewis C, Mutz J . Examining the association between family status and depression in the UK Biobank. J Affect Disord. 2020; 279:585-598. PMC: 7780845. DOI: 10.1016/j.jad.2020.10.017. View

18.

Fang N, Jiang M, Fan Y . Ideal cardiovascular health metrics and risk of cardiovascular disease or mortality: A meta-analysis. Int J Cardiol. 2016; 214:279-83. DOI: 10.1016/j.ijcard.2016.03.210. View

19.

Sun Y, Liu B, Rong S, Du Y, Xu G, Snetselaar L . Food Insecurity Is Associated With Cardiovascular and All-Cause Mortality Among Adults in the United States. J Am Heart Assoc. 2020; 9(19):e014629. PMC: 7792411. DOI: 10.1161/JAHA.119.014629. View

20.

Allen N, Zhao L, Liu L, Daviglus M, Liu K, Fries J . Favorable Cardiovascular Health, Compression of Morbidity, and Healthcare Costs: Forty-Year Follow-Up of the CHA Study (Chicago Heart Association Detection Project in Industry). Circulation. 2017; 135(18):1693-1701. PMC: 5476215. DOI: 10.1161/CIRCULATIONAHA.116.026252. View