The association between social determinants of health (SDOH) and increased rates of death due to cardiovascular disease (CVD) is mediated by behavioral and clinical risk factors, a new survey study shows. William J. He, MHS, from the Boston University Chobanian and Avedisian School of Medicine, and colleagues, reported these findings in a manuscript published online in JACC: Advances. CVD mortality is highly prevalent in communities with health disparities, low incomes and minority groups. Prior prospective cohort studies demonstrated that behavioral and metabolic risk factors are associated with a risk of developing CVD. Additionally, unfavorable SDOH — the influence from societal factors such as the availability and affordability of healthy food, social support structures and equitable healthcare — lead to a greater risk of CVD. Data were taken from the National Health and Nutrition Examination survey for social, behavioral and clinical risk factors. The National Death Index was used to derive CVD deaths through 2019. A total of 50,808 patients (mean age=47.2 years, 48.8% male) aged 20 years or older were included in the analysis. The researchers identified a dose-response association between the SDOH number and death due to cardiovascular causes. Patients who had a composite SDOH score greater than or equal to the median had an increased risk of CVD mortality 2.13 times more (95% confidence interval [CI]=1.91-2.37) than patients who had a score less than the median. The hazard ratio dropped to 1.67 (95% CI=1.50-1.86) after adjusting for behavioral and clinical risk factors. Mediators between CVD mortality and unfavorable SDOH included current smoking habits (relative contribution=11.4%, 95% CI=8.1%-14.8%), physical inactivity (relative contribution=7.7%, 95% CI=4.9%-10.6%), chronic kidney disease (relative contribution=5.5%, 95% CI=3.8%-7.1%), diabetes (relative contribution=2.0%, 95% CI=1.1%-2.9%) and unhealthy sleep duration times (relative contribution=1.8%, 95% CI=0.3%-3.3%). Additionally, 30.8% (95% CI=24.2%-37.5%) of overall CVD mortality that was attributed to negative SDOH was mediated by behavioral and clinical risk factors. Overall, the association between unfavorable SDOH and increased CVD mortality was at least partially mediated by separate behavioral and clinical risk factors. Source: He WJ, Geng S, Tian L, et al. Mediating effect of established risk factors on association between social determinants and cardiovascular disease mortality. JACC Advances. 2025 May 9 (Article in press). Image Credit: STOATPHOTO – stock.adobe.com