Development and Validation of a County-Level Social Determinants of Health Risk Assessment Tool for Cardiovascular Disease

Young‐Rock Hong · Arch G. Mainous

25 citations0/0 files storedThe Annals of Family Medicine

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Health disparities and outcomes Cardiovascular Health and Risk Factors Public Health and Social Inequalities

Abstract

PURPOSE Social determinants of health (SDoH) have been linked to a variety of health conditions, but there are no multivariate measures of these determinants to estimate the risk of morbidity or mortality in a community. We developed a score derived from multivariate measures of SDoH that predicts county-level cardiovascular disease (CVD) mortality. METHODS Using county-level data from 3,026 US counties, we developed a score considering variables of neighborhood socioeconomic status, food/lifestyle environment, and health care resource availability and accessibility to predict the 3-year average (2015-2017) age-adjusted county-level mortality rate for all CVD. We used one 50% random sample to develop the score and the other to validate the score. A Poisson regression model was developed to estimate parameters of variables while accounting for intrastate correlation. RESULTS The index score was based on 7 SDoH factors: percentage of the population of minority (nonwhite) race, poverty rate, percentage of the population without a high school diploma, grocery store ratio, fast-food restaurant ratio, after-tax soda price, and primary care physician supply. The area under the curve for the development and validation groups was similar, 0.851 (95% CI, 0.829-0.872) and 0.840 (95% CI, 0.817-0.863), respectively, indicating excellent discriminative ability. The index had better predictive performance for CVD burden than other area-level indexes: poverty only (area under the curve= 0.808, P <.001); the Centers for Disease Control and Prevention’s Social Vulnerability Index (CDC-SVI) (area under the curve =0.786, P <.001); and the Agency for Healthcare Research and Quality’s Socioeconomic Status (AHRQ-SES) index (area under the curve =0.835, P = .03). CONCLUSIONS Our validated multivariate SDoH index score accurately classifies counties with high CVD burden and therefore has the potential to improve CVD risk prediction for vulnerable populations and interventions for CVD at the county level.

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1991Health inequalities among British civil servants: the Whitehall II study 2011The Social Determinants of Health: Coming of Age 2003Area Deprivation and Widening Inequalities in US Mortality, 1969–1998 2014Neighborhood Socioeconomic Disadvantage and 30-Day Rehospitalization 2009Neighborhood built environment and income: Examining multiple health outcomes 2001Age Adjustment Using the 2000 Projected U.S. Population 2016Avoiding the Unintended Consequences of Screening for Social Determinants of Health 2001Age adjustment using the 2000 projected U.S. population.

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