A nationwide assessment of climate burden and cardiovascular health in US communities

Background Anthropogenic climate change has accelerated in the past decade, subjecting U.S. communities to increasingly hazardous conditions, such as record-high temperatures and more frequent wildfires, droughts, hurricanes, and flooding. However, the population-level impact of cumulative climate burden on cardiovascular health remains unexplored. Purpose To evaluate the nationwide association between climate burden and the prevalence of cardiovascular risk factors and diseases. Methods Data on the Climate Burden Index (CBI) were obtained from the Centers for Disease Control and Prevention (CDC) and the Agency for Toxic Substances and Disease Registry. The CBI is a percentile-ranked score (0 to 1) reflecting climate-related stressors in three domains: heat (extreme heat days), wildfires (frequency and proximity), and extreme events (flooding, drought, hurricanes, tornadoes). Tract-level prevalences of hypertension, hyperlipidemia, diabetes, stroke, coronary artery disease, and Social Vulnerability Index (SVI) scores were retrieved from the 2024 CDC PLACES dataset (Fig. 1). Adjusted risk differences were estimated using linear mixed-effects models, weighted by population size and incorporating region and county-level random effects. Results We analyzed 82,672 census tracts across the continental U.S., representing a total population of 328,714,059 in 2022 (median age, 40 years; 33% non-White). In fully adjusted models*, census tracts in the highest quartile (Q4) of the CBI had significantly higher mean (SD) prevalences of cardiovascular risk factors and diseases (Fig. 2) compared with those in the lowest quartile (Q1). Specifically, the mean (SD) prevalence of hypertension was 34.05% (6.61) in Q4 vs 33.84% (7.36) in Q1 (*adjusted difference, 1.279% [95% CI, 1.149%–1.410%]); hyperlipidemia, 35.85% (4.23) vs 34.37% (4.80) (1.804% [1.703%–1.905%]); diabetes, 12.47% (3.54) vs 12.50% (3.78) (0.213% [0.154%–0.273%]); coronary heart disease, 7.23% (2.14) vs 6.87% (2.26) (0.603% [0.563%–0.644%]); and stroke, 3.69% (1.21) vs 3.80% (1.47) (0.150% [0.128%–0.172%]). Conclusion Higher climate burden associated with elevated prevalences of cardiovascular risk factors and diseases across U.S. census tracts. These findings highlight the urgent need to integrate climate considerations into public health strategies, particularly in disproportionately affected communities. Further research is warranted to clarify causal mechanisms and inform targeted interventions at the intersection of climate change and cardiovascular health.Figure 1 Figure 2