Impact of Social Vulnerability on Diabetes‐Related Cardiovascular Mortality in the United States

Hussein Bashar · Ofer M. Kobo · Kamlesh K. Khunti · Amitava Banerjee · Renée P. Bullock-Palmer · Nick P. Curzen +1 more

10 citations0/0 files storedJournal of the American Heart Association

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Health disparities and outcomes Diabetes, Cardiovascular Risks, and Lipoproteins Public Health and Social Inequalities

Abstract

Background Social vulnerability impacts the natural history of diabetes as well as cardiovascular disease (CVD). However, there are little data regarding the social vulnerability association with diabetes-related CVD mortality. Methods and Results County-level mortality data (where CVD was the underlying cause of death with diabetes among the multiple causes) extracted from the Centers for Disease Control multiple cause of death (2015-2019) and the 2018 Social Vulnerability Index databases were aggregated into quartiles based on their Social Vulnerability Index ranking from the least (first quartile) to the most vulnerable (fourth quartile). Stratified by demographic groups, the data were analyzed for overall CVD, as well as for ischemic heart disease, hypertensive disease, heart failure, and cerebrovascular disease. In the 5-year study period, 387 139 crude diabetes-related cardiovascular mortality records were identified. The age-adjusted mortality rate for CVD was higher in the fourth quartile compared with the first quartile (relative risk [RR], 1.66 [95% CI, 1.64-1.67]) with an estimated 39 328 excess deaths. Among the youngest age group (<55 years), those with the highest social vulnerability had 2 to 4 times the rate of cardiovascular mortality compared with the first quartile: ischemic heart disease (RR, 2.07 [95% CI, 1.97-2.17]; heart failure (RR, 3.03 [95% CI, 2.62-3.52]); hypertensive disease (RR, 3.79 [95% CI, 3.45-4.17]; and cerebrovascular disease (RR, 4.39 [95% CI, 3.75-5.13]). Conclusions Counties with greater social vulnerability had higher diabetes-related CVD mortality, especially among younger adults. Targeted health policies that are designed to reduce these disparities are warranted.

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2017Structural racism and health inequities in the USA: evidence and interventions 2005At Risk: Natural Hazards, People's Vulnerability, and Disasters 2020Social Determinants of Health and Diabetes: A Scientific Review 2020How Structural Racism Works — Racist Policies as a Root Cause of U.S. Racial Health Inequities 2015Social Determinants of Risk and Outcomes for Cardiovascular Disease 2015County Health Rankings 2022Social Determinants of Cardiovascular Disease 2019The Impact of Unconscious Bias in Healthcare: How to Recognize and Mitigate It

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