Association of cumulative social risk with mortality and adverse cardiovascular disease outcomes

Sebhat Erqou, Justin B. Echouffo-Tcheugui, Kevin E. Kip, Aryan Aiyer, Steven E. Reis

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


Background: Quantifying the cumulative effect of social risk factors on cardiovascular disease (CVD) risk can help to better understand the sources of disparities in health outcomes. Method and results: Data from the Heart Strategies Concentrating on Risk Evaluation (HeartSCORE) study were used to create an index of cumulative social risk (CSR) and quantify its association with incident CVD and all-cause mortality. CSR was defined by assigning a score of 1 for the presence of each of 4 social factors: i) racial minority status (Black race), ii) single living status, iii) low income, and iv) low educational level. Hazard ratios (HRs) were computed using Cox-regression models, adjusted for CVD risk factors. Over a median follow-up period of 8.3 years, 127 incident events were observed. The incidence of the primary outcome for subgroups of participants with 0, 1, and ≥2 CSR scores was 5.31 (95% CI, 3.40-7.22), 10.32 (7.16-13.49) and 17.80 (12.94-22.67) per 1000 person-years, respectively. Individuals with CSR score of 1 had an adjusted HR of 1.85 (1.15-2.97) for incident primary outcomes, compared to those with score of 0. The corresponding HR for individuals with CSR score of 2 or more was 2.58 (1.60-4.17). Conclusion: An accumulation of social risk factors independently increased the likelihood of CVD events and deaths in a cohort of White and Black individuals.

Original languageEnglish (US)
Article number110
JournalBMC Cardiovascular Disorders
Issue number1
StatePublished - May 8 2017
Externally publishedYes


  • Cardiovascular disease
  • Cumulative social risk
  • Racial disparity
  • Social risk factors

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


Dive into the research topics of 'Association of cumulative social risk with mortality and adverse cardiovascular disease outcomes'. Together they form a unique fingerprint.

Cite this