Social Drivers of Health Advisory

BACKGROUND: Social drivers of health (SDOH) are major contributors to future disease. As the population ages, it is important to understand projections of cardiovascular disease (CVD) according to SDOH. OBJECTIVES: The objective of the study was to determine CVD projections according to education, insurance, and income. METHODS: We estimated future projections of risk factors for CVD, individual CVD conditions (ie heart failure), and total CVD from 2020 to 2050 according to SDOH of the United States using the National Health and Nutrition Examination Survey, Medical Expenditure Panel Survey, and U.S. Census. RESULTS: By 2050, most risk factors and individual CVD conditions are estimated to worsen and remain the worst for those with less education, Medicare or Medicaid beneficiaries, and lower income. Counterintuitively from 2020 to 2050, total CVD prevalence is expected to incrementally increase with higher levels of education (10.0 percentage points higher for college graduates), reaching similar prevalence across education levels by 2050. Medicare beneficiaries are projected to have the highest prevalence of total CVD throughout the era, reaching 86% by 2050. Increases in total CVD prevalence are projected to be similar across income categories. CONCLUSIONS: Total CVD prevalence is projected to increase from 2020 to 2050 across education, insurance, and income categories with greatest increases occurring in those with a college degree. However, multiple risk factors, most CVD conditions, and total CVD prevalence are generally projected to be highest among populations with less education, public insurance, and lower income compared to respective SDOH categories. Efforts to address SDOH should be prioritized to mitigate the forecast.