Unfavorable Health-Related Social Needs Associated With Lower Cardiovascular Health Scores

Adults with more unfavorable health-related social needs (HRSNs) had a graded positive association with low cardiovascular health (CVH) and an adverse association with high CVH, according to a study published in Journal of the American Heart Association.¹

HRSNs include social and economic factors that impact an individual’s ability to maintain their health and well-being, such as unemployment, food insecurity, financial barriers, and educational attainment. The researchers emphasized that understanding factors associated with low CVH may help to identify and address potential barriers, ultimately improving population health.

In 2010, the American Heart Association (AHA) released Life’s Simple 7, a set of 7 metrics designed to improve CVH among all Americans by 20%.² These metrics included body mass index (BMI), physical activity, smoking, dietary intake, blood pressure, total cholesterol, and fasting glucose. AHA expanded these metrics in 2022 with Life’s Essential 8 (LE8), which added sleep health as an additional metric.³

Previous research found that higher LE8 scores are associated with a lower risk of all-cause and cardiovascular disease (CVD) mortality.¹ However, the relationship between HRSNs and LE8 has not been thoroughly explored within the US population. Given these gaps, the researchers aimed to evaluate the associations between HRSNs and LE8, both individually and collectively, among US adults aged 20 and older.

Adults with more unfavorable health-related social needs, such as unemployment or food insecurity, had a higher prevalence of low cardiovascular health. | Image Credit: BillionPhotos.com - stock.adobe.com

They used data from the January 2011 to March 2020 National Health and Nutrition Examination Survey (NHANES), a nationally representative, cross-sectional survey that assessed the nutrition and health status of the US population. Those selected underwent an in-person interview at home, followed by an examination at the NHANES Mobile Examination Center.

Healthy People 2030 group social determinants of health (SDOH) into 5 domains: economic stability, health care access and quality, education access and quality, neighborhood and built environment, and social and community context. Based on these, the researchers identified 8 HRSN components: employment status, family poverty-to-income ratio, education level, food security, health care access, health insurance status, home ownership, and marriage status.

For each participant, they summed the number of HRSNs, ranging from 0 to 8; higher numbers indicated more unfavorable HRSNs. The researchers categorized unfavorable HRSNs as none, 1 to 2, 3 to 4, and 5 or more.

Additionally, each LE8 metric score ranged from 0 to 100, with a higher score indicating better health. The overall LE8 score was the mean of the 8 metric components and was categorized as low (< 50), moderate (50-79), and high (≥ 80) CVH. After calculating both scores, the researchers used multivariable linear and multinomial logistic regression models to examine the association between HRSNs and CVH.

They analyzed 14,947 NHANES participants, who had a mean (SE) age of 46.4 (0.35) years. About half of the participants (49.3%) were male, and nearly two-thirds were non-Hispanic White (66.3%). Additionally, the mean number of unfavorable HRSNs was 1.79 (0.04). Of the study population, 29.1%, 40.1%, 21.5%, and 9.0% had 0, 1 to 2, 3 to 4, and 5 or more HRSNs, respectively.

Those who were younger, non-Hispanic Black, Hispanic, or who had mild or moderate to severe depressive symptoms had more unfavorable HRSNs. The least common HRSN factors were having lower than a high school education (11.2%), being uninsured (16.2%), being unemployed (17.3%), and having no access to health care (18.5%). Conversely, the most prevalent factors were no home ownership (33.5%) and never being married or living alone (37.0%).

Also, the mean overall CVH score was 66.4, with the prevalence of low, moderate, and high CVH being 14.7%, 63.5%, and 21.8%, respectively. The mean scores were lowest for BMI (59.1), physical activity (53.2), and diet (40.0), and they were highest for sleep (84.5) and blood glucose (84.4). Overall, higher numbers of unfavorable HRSNs were associated with a higher prevalence of low CVH and a lower prevalence of high CVH.

The fully adjusted prevalence ratios (PRs) for low CVH were 1.42 (95% CI, 1.17-1.73), 2.11 (95% CI, 1.69-2.63), and 2.42 (95% CI, 1.90-3.08) for participants with 1 to 2, 3 to 4, or 5 or more HRSNs, respectively. Conversely, the corresponding PRs were 0.77 (95% CI, 0.68-0.87), 0.58 (95% CI, 0.49-0.67), and 0.46 (95% CI, 0.38-0.55) for high CVH among participants with 1 to 2, 3 to 4, or 5 or more HRSNs, respectively. The researchers noted that these associations were consistent across subgroups and in sensitivity analyses.

Lastly, they acknowledged their limitations, including the study’s cross-sectional nature. Consequently, the researchers could not interpret the overall and individual associations between HRSNs and CVH as directly causal. Despite this, they expressed confidence in their findings and used them to promote future CVH efforts.

“Implementation of multipronged approaches, including community-engaged interventions and health-related policies in conjunction with HRSNs throughout the life course, may help promote CVH,” the authors concluded.

References

1. Zhang Z, Jackson SL, Thompson-Paul AM, Yin X, Merritt RK, Coronado F. Associations between health-related social needs and cardiovascular health among US adults. J Am Heart Assoc. doi:10.1161/JAHA.124.035863

2. Lloyd-Jones DM, Hong Y, Labarthe D, et al. 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

3. Lloyd-Jones DM, Allen NB, Anderson CAM, et al. Life’s Essential 8: updating and enhancing the American Heart Association’s construct of cardiovascular health: a presidential advisory from the American Heart Association. Circulation. 2022;146(5). doi:10.1161/cir.0000000000001078