Social determinants of health, life’s essential 8 metrics, and cardiovascular morbidity and mortality: a nationwide cohort study

Background: Life's Essential 8 (LE8) provides a framework to assess and improve cardiovascular health, ultimately reducing cardiovascular disease (CVD) risk. However, the role of LE8 metrics in addressing CVD disparities associated with social determinants of health (SDoH) remains unclear. Methods: This cohort study employed the National Health and Nutrition Examination Survey (2005-2018) data. Logistic regression models, Cox proportional hazard models, and multiple mediation analysis were used to assess the associations of the SDoH score with CVD morbidity (self-reported diagnosis of congestive heart failure, coronary heart disease, angina pectoris, myocardial infarction, and stroke), CVD mortality, and mortality (mortality data were derived from the NHANES Public-Use Linked Mortality File), as well as the contributions of LE8 metrics to the associations. Results: The top four reported unfavorable SDoH were low education level (21.5%), income-to-poverty ratio <3 (17.5%), no private health insurance (13.0%), and unemployment (11.5%). Unfavorable SDoH exposure was associated with higher CVD morbidity [odds ratio (OR) and 95% confidence interval (CI): 2.36 (2.18, 2.55) and CVD mortality [hazard ratio (HR) and 95%CI: 2.70 (2.24, 3.24)]. LE8 metrics accounted for approximately 30.4% (95%CI: 26.2%, 34.7%), 23.0% (95%CI: 19.3%, 28.3%), and 24.0% (95%CI: 20.6%, 28.8%) of the association between SDoH and CVD morbidity, CVD mortality, and all-cause mortality, respectively, with nicotine exposure, physical activity, and sleep health being the main LE8 contributors. Differences in the distribution of SDoH components, as well as the contribution of LE8 to the association between SDoH and CVD risk were observed across race/ethnicity groups. Conclusions: Our findings highlight the effectiveness for public health interventions targeting SDoH to improve LE8 metrics and ultimately reducing CVD morbidity and mortality. Future research should also explore the impact of non-LE8 factors and racial/ethnic differences in developing comprehensive CVD prevention strategies among U.S. adults.