Key result
Multiple cumulative social risks are linked to ~7.1-fold higher odds of low cardiovascular health.
Why the study?
Cardiovascular health disparities persist in the U.S., but few studies have examined how individual and cumulative social risks relate to cardiovascular health across sex.
Does cumulative social risk reduce cardiovascular health (measured by Life's Essential 8 scores) in U.S. adults, and does this effect vary by sex?
Cross-Sectional (n=21,625)
Does cumulative social risk reduce cardiovascular health (measured by Life's Essential 8 scores) in U.S. adults, and does this effect vary by sex?
Individual and cumulative social risks are robustly associated with lower cardiovascular health, with a disproportionately severe burden placed on females.
Social risk screening may inform CVH discussions; leaves open causal effects and intervention benefits in prospective studies.
Cardiovascular health (CVH) disparities persist in the U.S., often shaped by social risk factors. However, few studies have examined how individual and cumulative social risks relate to CVH across sex. We analyzed cross-sectional data from the 2013–2023 National Health and Nutrition Examination Survey (NHANES). CVH was defined by Life’s Essential 8 (LE8) which includes diet, physical activity, nicotine exposure, sleep, body mass index, blood lipids, blood glucose, and blood pressure. LE8 scores range from 0 to 100 and were categorized as low (<50), moderate (50–79), or high (≥80). Social risk was defined across six domains: low income, low education, minoritized race or ethnicity, single-living status, lack of health insurance, and unemployment, summed and categorized as 0, 1, 2, 3, or ≥4 risks. Weighted multinomial logistic regression models adjusted for age were used to estimate associations. Among 21,625 adults (representing ≈226 million U.S. adults), the mean age was 46.4 years. Low education was associated with 2.34 times higher odds of low CVH in males (95% CI: 1.72–3.20) and 1.83 times higher odds in females (95% CI: 1.38–2.43). Low income was linked to 2.79 times higher odds of low CVH in females (95% CI: 2.08–3.75). Unemployment was associated with 2.56 times higher odds of low CVH in males (95% CI: 1.91–3.44). Adults with ≥4 social risks had 7.14 times higher odds of low CVH in females and 6.05 in males. Mean LE8 scores declined from 68.0 to 60.9 in females and from 67.2 to 60.3 in males over the decade. Individual and cumulative social risks were strongly associated with lower CVH, with women bearing a greater burden. These findings highlight the need for policies that address social factors to reduce sex-based disparities and improve CVH.
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Metlock et al. (2026) conducted a cross-sectional in Cardiovascular Health (Life's Essential 8) (n=21,625). Cumulative social risk (≥4 risk factors) vs. Zero social risk factors was evaluated on Low Cardiovascular Health (Life's Essential 8 score <50) (aOR 7.14, 95% CI 5.15-9.90). Having ≥4 cumulative social risks was associated with 7.14 times higher odds of low cardiovascular health in females and 6.05 times higher odds in males compared to having no social risks.
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