The Association of the Social Deprivation Index with the Development of Peripheral Arterial Disease in the Multi-Ethnic Study of Atherosclerosis (MESA)

Peripheral arterial disease (PAD) has many established risk factors, but social determinants of health (SDoH) are increasingly recognized as a cardiovascular disease risk factor. The Multi-Ethnic Study of Atherosclerosis (MESA) cohort was employed to evaluate if neighborhood-level SDoH, represented by the social deprivation index (SDI), provide additional PAD risk prediction beyond the established risk factors. 5,580 individuals from the MESA cohort had social deprivation index (SDI) scores calculated at the zip code tabulation area (ZCTA) geographic level. Incident PAD, established by an ankle-brachial index (ABI) of < 0.9, was the outcome of interest. Two sets of logistic regression models evaluated the SDI's impact on established PAD risk factors. Black and Hispanic individuals lived in areas with more social deprivation than White and Chinese individuals. With SDI incorporation, age (Odds Ratio [OR] 1.08 per year, p-value < 0.001), treated diabetes (OR 2.02, p-value 0.002), and both current (OR 3.16, p-value < 0.001) and former (OR 1.43, p-value 0.022) cigarette smoking were significantly associated with incident PAD. After SDI removal, there were no consequential changes in significant associations and ORs. Across all measured risk factors, SDI score incorporation did not significantly modify PAD development. The overall composite SDI score's association with incident PAD was not significant (OR 1.00, p-value 0.437). The SDI's addition to recognized risk factors did not enhance PAD risk prediction. SDI scores had prominent racial/ethnic disparity. In conclusion, the SDI's impact on PAD development is likely upstream to known risk factors, so its incorporation provides no additional risk.