Developing a county-level cardiovascular health score utilizing the American heart Association's Life's essential 8 framework: How important is the geographic patterning of cardiovascular health across US counties?

The American Heart Association (AHA) updated a novel construct of cardiovascular health (CVH) in 2022 as Life's Essential 8 (LE8). This measure of CVH has been widely used at the individual level to assess mortality and chronic disease risk. Despite its clinical relevance, LE8 has not been operationalized at a population level to capture contextual cardiovascular health environments. Ecological study design. Utilizing data from two publicly available datasets found in the Centers for Disease Control and Prevention's PLACES and the County Health Rankings and Roadmap data, we address the following goals: (1) create a county-level CVH score based on the newest AHA's LE8 framework; (2) measure and map the geographic heterogeneity in the county-level CVH score to understand the patterning of CVH across US counties; (3) assess the association between key social determinants of health and county-level CVH scores to capture the contextual cardiovascular health environment. We create a novel county-level CVH score based on the LE8 framework and examine the distribution of the score across the US. Our maps highlight significant spatial heterogeneity with noticeable clustering. Regression models revealed that air pollution and primary care access were significant predictors of the county-level CVH score. This is one of the first constructions of the LE8 framework at the county-level, representing the CVH environment across the US. Findings from our research can inform policy and interventions aimed toward improving CVH, especially those that consider the geographic boundaries of counties, and the environmental and healthcare context.