Cardiovascular Disease Risk Tied to Social, Environmental Disparities

In the United States, increased social and environmental disparities are associated with a higher prevalence of cardiovascular disease (CVD) and its risk factors, according to study results published in the Journal of the American Heart Association.

Researchers conducted a cross-sectional observational study to explore the combined effects of environmental and social exposures on CVD risk in the US. The researchers obtained crude prevalence rates of CVDs and risk factors via the Centers for Disease Control and Prevention (CDC) 2022 Population-Level Analysis and Community Estimates: Local Data for Better Health database. Socioenvironmental justice index and environmental burden module ranks of census tracts were divided into quartiles (ranging from quartile 1 [0.00-0.25], least socially vulnerable population and lowest environmental impact to quartile 4 [0.75-1.00], most socially vulnerable population and highest environmental impact) using the 2022 Environmental Justice Index (EJI). Age-adjusted rate ratios (RRs) of the prevalence of cardiovascular health measures were compared among quartiles using multivariable Poisson regression.

EJI and environmental burden module quartile 1 had the highest median percentages of White and non-Hispanic adults, individuals aged 45 to 64, as well as those aged 65 and older. Quartile 4 of the EJI and environmental burden module had the highest median percentages in individuals aged 18 to 44 and Black adults.

Between 2015 and 2019, the prevalence of coronary artery disease (CAD) was highest in EJI quartile 4 and lowest in EJI quartile 1 (RR, 1.684; 95% CI, 1.660-1.708).

Stroke was most prevalent in EJI quartile 4 and least prevalent in quartile 1 (RR, 2.112; 95% CI, 2.078-2.147). This pattern of prevalence was also observed for chronic kidney disease.

Hypertension (RR, 1.561; 95% CI, 1.540-1.583) and diabetes (RR, 2.024; 95% CI, 1.993-2.056) were most prevalent in EJI quartile 4 and least prevalent in quartile 1.

Similar patterns of low and high prevalence in EJI quartiles 1 and 4, respectively, were observed for high cholesterol, obesity, lack of health insurance, fewer than 7 hours of sleep, no leisure time physical activity, and impaired physical and mental health for more than 2 weeks.

The risk for CAD (RR, 1.143; 95% CI, 1.127-1.159) and stroke (RR, 1.118; 95% CI, 1.102-1.135) was greater in quartile 4 vs quartile 1 of the environmental burden module.

Study limitations included the use of aggregate data at the census tract level; potential confounding; the inability of EJI to consider data regarding drinking water quality, low infant birth weight, and pesticide usage; and the inability of EJI to comprehensively capture all environmental, social, and health vulnerabilities.

“Policies to protect against climate change, reduce environmental pollution, and decrease social disparity are needed to improve cardiovascular health outcomes, particularly in vulnerable populations,” the researchers concluded.

Disclosures: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.