Social Determinants of Health Correlates and Atherosclerotic Cardiovascular Disease Risk Among Adults in Baltimore: The EngAGE With Heart Study

BACKGROUND: Social determinants of health (SDOHs) are linked with cardiovascular health, yet timely community-based atherosclerotic cardiovascular disease (ASCVD) risk assessment is often limited. We examined the associations between SDOHs and ASCVD risk among adults in Baltimore. METHODS: This cross-sectional study of 4 Black faith-based communities in Baltimore assessed the cardiovascular health of adults aged 40 to 79 years. We estimated ASCVD risk using the 2013 American College of Cardiology/American Heart Association pooled cohort equations (PCE) and dichotomized risk as high or low. SDOHs were quantified with an 8-item score drawn from the Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences tool. We fit linear and logistic regression models to examine the association between SDOHs and high ASCVD risk after adjusting for age, sex, body mass index, and alcohol use. RESULTS: Among 118 Black adults, the mean±SD age was 64±9 years, with 85% women. Overall, the mean ASCVD risk score was 13.1%, and the median (interquartile range) was 10.2% (5.0%–19.0%). The majority (63%) had high ASCVD risk (≥7.5%). About 84% of participants reported ≥1 unfavorable SDOHs. In the fully adjusted model, low income, unemployment, having no primary care provider, and having ≥1 unfavorable SDOHs were associated with high ASCVD risk. We also observed significantly higher odds of ASCVD among individuals with 2 unfavorable SDOHs compared with those with none. CONCLUSIONS: We found associations between lower income, unemployment, and multiple unfavorable SDOHs with greater ASCVD risk. Our findings suggest the need for socioeconomic policies to improve cardiovascular health, particularly among Black individuals.