Developing a Novel Index for Individual-Level Social Determinants and Cardiovascular Diseases in the Coronary Artery Risk Development in Young Adults (CARDIA) Study

Tao Gao, Yinan Zheng, Brian Joyce, Lei Liu, Lili Liu, Catarina Kiefe, Sarah Forrester, Bing Yu, Ankeet Bhatt, Penny Gordon-Larsen, Donald Lloyd-Jones, Kai Zhang () and Lifang Hou ()
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Tao Gao: Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
Yinan Zheng: Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
Brian Joyce: Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
Lei Liu: Division of Biostatistics, Washington University in St. Louis, St. Louis, MO 63110, USA
Lili Liu: Division of Biostatistics, Washington University in St. Louis, St. Louis, MO 63110, USA
Catarina Kiefe: Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA 01655, USA
Sarah Forrester: Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA 01655, USA
Bing Yu: Department of Epidemiology and Human Genetics Center, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
Ankeet Bhatt: Division of Research, Kaiser Permanente San Francisco Medical Center, San Francisco, CA 94588, USA
Penny Gordon-Larsen: Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
Donald Lloyd-Jones: Preventive Medicine & Epidemiology Section, and Framingham Center for Population & Prevention Science, Boston University School of Medicine, Boston, MA 02118, USA
Kai Zhang: Department of Population and Community Health, College of Public Health, The University of North Texas Health Science Center at Fort Worth, Fort Worth, TX 76107, USA
Lifang Hou: Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA

IJERPH, 2025, vol. 22, issue 3, 1-10

Abstract: Background: Social determinants of health (SDH) have been found to contribute to cardiovascular risk and the development of cardiovascular disease (CVD). However, few studies have examined early-life exposure to SDH and the combined effect of multiple SDH measures on CVD. There is an urgent need to develop an SDH index for use in practice and clinical settings. Methods: A total of 3189 participants from the CARDIA Study who had chest CT scans at the year-25 (Y25) visit were included in this study. Personal and parental SDH measures, including education, occupation, income, financial strain, and childhood family environment, were obtained through interviews. The participants’ coronary artery calcification (CAC) was measured using chest CT scans, and left-ventricular mass (LVM) was measured using M-mode echocardiography. The values of the individual social determinants of health (iSDH) index were determined based on individual-level measures and CAC using a supervised learning method—the Boosted Regression Tree (BRT) model. This index’s association with the LVM index (LVMI) was evaluated as an external validation using linear regression models adjusting for race, sex, BMI, smoking status, alcohol intake, and physical activity. Results: Each one-standard-deviation (SD) increase in the iSDH index was associated with an increase in LVMI ranging from 0.376 (95% CI −0.016, 0.767) at year 0 to 0.468 (95% CI 0.115, 0.821) at year 20. The association between the iSDH index and the LVMI was more pronounced as the participants aged. Also, the iSDH indices were more strongly associated with LVMI among Black participants (β = 0.969, 95% CI = 0.081, 1.858) than White participants (β = 0.202, 95% CI = −0.228, 0.633) at year 5. Conclusions: Higher iSDH indices in early adulthood were associated with increased LVMI values in midlife. The association between the iSDH index and CVD was stronger among Black adults than with White adults.

Keywords: social determinants of health; coronary artery calcification; left ventricular mass (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2025
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