Associations of Sociodemographic and Neighborhood Vulnerability With Cardiovascular Health in Midlife Women in the United States

Q: What are the key findings of this study?

Residence in very high versus very low Social Vulnerability Index neighborhoods was associated with persistently lower cardiovascular health scores across up to 23 years of follow-up, including a mean difference of -6.7 points at 3 years.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Suboptimal cardiovascular health (n=1200). Intervention: Very high neighborhood Social Vulnerability Index (SVI) vs. Very low neighborhood Social Vulnerability Index (SVI). Primary outcome: Mean difference in Cardiovascular Health (CVH) score at 3-year follow-up (MD -6.7, 95% CI -12.3 to -1.2).

Q: What does this research mean for the field?

Disadvantaged sociodemographic status and persistent residence in highly vulnerable neighborhoods are independently associated with lower cardiovascular health scores and faster health decline across the menopausal transition in midlife women. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Zhi Lin; Sheryl L. Rifas‐Shiman; Wei Perng; Li Yi; JoAnn E. Manson; Hadine Joffe; Marie‐France Hivert; Jorge E. Chavarro; Izzuddin M. Aris

doi:10.1161/circoutcomes.126.013433

July 17, 2026Circulation Population Health and OutcomesOpen Access

Associations of Sociodemographic and Neighborhood Vulnerability With Cardiovascular Health in Midlife Women in the United States

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Key result

High neighborhood social vulnerability is linked to ~7-point lower cardiovascular health scores over follow-up.

MD -6.7
95% CI -12.3 to -1.2
n=1,200

Why the study?

Many women have suboptimal cardiovascular health that declines during midlife, but few studies have characterized cardiovascular health across the menopausal transition or identified its sociodemographic and neighborhood determinants.

Do disadvantaged sociodemographic backgrounds and vulnerable neighborhoods accelerate cardiovascular health decline in midlife women?

Key Points

To examine the longitudinal associations of individual sociodemographics and neighborhood vulnerability with cardiovascular health trajectories across the menopausal transition.
Prospective cohort of 1,200 pregnant women enrolled in eastern Massachusetts (1999-2002) and followed for up to 23 years (2019-2024).
Cardiovascular health (CVH) was assessed at 3-, 8-, 13-, 18-, and 23-year visits using Life's Essential 8 (0-100 scale), alongside neighborhood vulnerability classified by Social Vulnerability Index (SVI).
Linear spline mixed-effects models analyzed CVH scores across premenopause, perimenopause, and postmenopause stages after covariate adjustment.
Residence in very high versus very low SVI neighborhoods from enrollment to 3-year follow-up was associated with lower mean CVH across follow-up: -6.7 points (95% CI, -12.3 to -1.2) at 3 years, -9.8 points (95% CI, -15.6 to -4.0) at 8 years, -8.9 points (95% CI, -13.9 to -3.9) at 13 years, -6.7 points (95% CI, -12.9 to -0.5) at 18 years, and -7.2 points (95% CI, -12.5 to -1.9) at 23 years.
Women residing in very high SVI neighborhoods experienced a faster rate of CVH score decline during premenopause (-0.62 points/year; 95% CI, -1.22 to -0.02).
Lower household income (≤$40,000/year), lower education, and Non-Hispanic Black race were independently associated with persistently lower CVH scores across follow-up.

Study Design

Type

Cohort (n=1,200)

Multicenter

No

Structured PICO

Do disadvantaged sociodemographic backgrounds and vulnerable neighborhoods accelerate cardiovascular health decline in midlife women?

P

Population

1,200 women enrolled during pregnancy in eastern Massachusetts and followed for up to 23 years to assess cardiovascular health trajectories across the menopausal transition.

E

Exposure

Lower household income, lower education, Non-Hispanic Black race, and residence in high Social Vulnerability Index (SVI) neighborhoods

C

Comparator

Higher household income, higher education, Non-Hispanic White race, and residence in very low SVI neighborhoods

O

Outcome

Cardiovascular health (CVH) scores (0-100 points) derived using Life's Essential 8 at 3-, 8-, 13-, 18-, and 23-year follow-up visitssurrogate

Main Result

Mean Difference: -6.7 (95% CI -12.3–-1.2)

Women from disadvantaged sociodemographic backgrounds or residing in vulnerable neighborhoods exhibit persistently poorer cardiovascular health and faster decline across the menopausal transition.

Limitations

Self-reported menopause status
SVI exposure based on census tracts may not reflect lived experiences
SVI does not capture residential air quality or crime rate
Missing CVH components at some follow-up periods
Excluded participants exhibited sociodemographic differences
Parous, predominantly Non-Hispanic White, insured women from eastern Massachusetts limits generalizability
Used self-reported menopause status
SVI exposure was based on census tracts, which may not reflect neighborhood boundaries most relevant to women's lived experiences
SVI does not capture certain characteristics, such as residential air quality or crime rate
Did not collect all 8 CVH components at some follow-up periods
Excluded participants exhibited some sociodemographic differences from included participants, which could introduce selection bias
Women in the study were parous, predominantly Non-Hispanic White, had health insurance, and recruited from eastern Massachusetts, limiting generalizability

Implication

High neighborhood vulnerability was associated with lower CVH in midlife women; extends social determinants evidence while leaving causal and interventional questions open.

Abstract

BACKGROUND: Many women have suboptimal cardiovascular health (CVH), which declines during midlife. Few studies have characterized CVH across the menopausal transition or identified its sociodemographic and neighborhood determinants. METHODS: We analyzed a prospective cohort of women in eastern Massachusetts enrolled during pregnancy (1999-2002) and followed to midlife (2019-2024). Exposures included household income, education, race and ethnicity, and neighborhood Social Vulnerability Index (categorized from very low [<20th percentile] to very high [≥80th percentile]; higher categories=greater neighborhood vulnerability). Women self-reported their menopause status using questionnaires. Using Life's Essential 8, we derived CVH scores (0-100 points; higher score=better CVH) at 3-, 8-, 13-, 18-, and 23-year follow-up visits. Linear spline mixed-effect models examined associations of sociodemographics and neighborhood Social Vulnerability Index with differences in CVH across different menopause stages (premenopause, perimenopause, and postmenopause). RESULTS: Among 1200 women (mean enrollment age, 32.1 years; 67.5% Non-Hispanic White), 15.4% had household incomes ≤$40 000/y, 8.8% had ≤high school education, and 17.4% resided in very high Social Vulnerability Index neighborhoods. After covariate adjustment, women with lower income, lower education, or identifying as Non-Hispanic Black exhibited lower CVH across follow-up. Independent of individual sociodemographics, continued residence in vulnerable neighborhoods over time was associated with lower CVH and unfavorable CVH trajectories across follow-up. For example, residence in very high (versus very low) Social Vulnerability Index neighborhoods from enrollment to 3-year follow-up corresponded to mean CVH differences of -6.7 (95% CI, -12.3 to -1.2) at 3-year, -9.8 (95% CI, -15.6 to -4.0) at 8-year, -8.9 (95% CI, -13.9 to -3.9) at 13-year, -6.7 (95% CI, -12.9 to -0.5) at 18-year, and -7.2 (95% CI, -12.5 to -1.9) at 23-year follow-up, and with faster CVH score decline during premenopause (-0.62 points/y; 95% CI, -1.22 to -0.02). CONCLUSIONS: Women from disadvantaged sociodemographic backgrounds or residing in vulnerable neighborhoods exhibit poorer CVH across the menopausal transition, highlighting opportunities to optimize long-term CVH and mitigate cardiovascular disease risk.

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Cite This Study

Lin et al. (2026) conducted a cohort in Suboptimal cardiovascular health (n=1,200). Very high neighborhood Social Vulnerability Index (SVI) vs. Very low neighborhood Social Vulnerability Index (SVI) was evaluated on Mean difference in Cardiovascular Health (CVH) score at 3-year follow-up (MD -6.7, 95% CI -12.3 to -1.2). Residence in very high versus very low Social Vulnerability Index neighborhoods was associated with persistently lower cardiovascular health scores across up to 23 years of follow-up, including a mean difference of -6.7 points at 3 years.

synapsesocial.com/papers/6a5b38f68167787360d24e60 https://doi.org/10.1161/circoutcomes.126.013433

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Associations of Sociodemographic and Neighborhood Vulnerability With Cardiovascular Health in Midlife Women in the United States

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Associations of Sociodemographic and Neighborhood Vulnerability With Cardiovascular Health in Midlife Women in the United States

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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