Impacts of social determinants on cardio-kidney-metabolic disease vary greatly across US
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Key takeaways:
- Size of associations for social determinants of health and cardio-kidney-metabolic disease-related deaths varied by region.
- Researchers used geographically weighted models to reveal differential effects.
A county-level assessment of deaths from cardio-kidney-metabolic disease and social determinants of health revealed that particular determinants are more or less important in different U.S. regions, researchers reported in JAMA.
Pedro Vieira de Oliveira Salerno, MD, a post-doctoral fellow at Harrington Heart and Vascular Institute and Case School of Medicine, Case Western Reserve University in Cleveland, and colleagues used geographically weighted regression models to assess effects of social determinants of health on deaths related to cardio-kidney-metabolic diseases — cardiovascular disease, kidney disease, metabolic syndrome, obesity and diabetes — in 95.6% of U.S. counties from 2010 to 2019. They used from the CDC Wide-Ranging Online Data for Epidemiologic Research (WONDER) data portal on mortality rates and seven social and environmental factors related to cardiovascular health: racial/ethnic mix of residents; percentage of rural residents; air pollution fine particulate matter concentration; median household income; high school completion rate; food insecurity and access to health care.
The researchers found each of the identified social determinants of health was associated with mortality related to cardio-kidney-metabolic diseases. The determinants most significantly associated with increased mortality were food insecurity and lower rate of high school completion, according to the researchers. The most important determinant associated with decreased mortality was higher median household income, according to the researchers.
In addition, the size of the associations was different across different geographic regions.
“Although, we know that high rates of air pollution, food insecurity or primary health care access are all linked with poor health overall, in your locality or county, the relative importance of these conditions may be different,” researcher Salil V. Deo, MD, associate professor in the department of surgery at Case School of Medicine, Case Western Reserve University, told Healio.
Many counties had both high levels of food insecurity and high cardio-kidney-metabolic mortality rates “underlining the fact that food insecurity may be an important issue in many counties when considering [cardio-kidney-metabolic mortality] rates,” Deo said.
Many counties across the South had lower household income and high relevant death rates.
“This study uses a unique statistical approach — geographically weighted modeling to demonstrate that different factors are important in different regions of the U.S.,” Deo said.
The methodology and findings should inform local public policy, the researchers wrote.
“Till now, most approaches have focused on trying to identify factors associated with cardiovascular disease in the entire U.S. However, the U.S. is racially, socially and geographically diverse; therefore, policies need to be tailored to best tackle the issues prevalent in specific regions.”
For more information:
Salil V. Deo, MD, can be reached at svd14@case.edu.
Pedro Vieira de Oliveira Salerno, MD, can be reached on X (Twitter): @pedrorvosalerno.
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