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Impact of Social Vulnerability on Diabetes‐Related Cardiovascular Mortality in the United States

Bashar, Hussein; Kobo, Ofer; Khunti, Kamlesh; Banerjee, Amitava; Bullock‐Palmer, Renee P.; Curzen, Nick; Mamas, Mamas A.


Hussein Bashar

Ofer Kobo

Kamlesh Khunti

Amitava Banerjee

Renee P. Bullock‐Palmer

Nick Curzen


Social vulnerability impacts the natural history of diabetes as well as cardiovascular disease (CVD). However, there are little data regarding the social vulnerability association with diabetes‐related CVD mortality.

Methods and Results
County‐level mortality data (where CVD was the underlying cause of death with diabetes among the multiple causes) extracted from the Centers for Disease Control multiple cause of death (2015–2019) and the 2018 Social Vulnerability Index databases were aggregated into quartiles based on their Social Vulnerability Index ranking from the least (first quartile) to the most vulnerable (fourth quartile). Stratified by demographic groups, the data were analyzed for overall CVD, as well as for ischemic heart disease, hypertensive disease, heart failure, and cerebrovascular disease. In the 5‐year study period, 387 139 crude diabetes‐related cardiovascular mortality records were identified. The age‐adjusted mortality rate for CVD was higher in the fourth quartile compared with the first quartile (relative risk [RR], 1.66 [95% CI, 1.64–1.67]) with an estimated 39 328 excess deaths. Among the youngest age group (<55 years), those with the highest social vulnerability had 2 to 4 times the rate of cardiovascular mortality compared with the first quartile: ischemic heart disease (RR, 2.07 [95% CI, 1.97–2.17]; heart failure (RR, 3.03 [95% CI, 2.62–3.52]); hypertensive disease (RR, 3.79 [95% CI, 3.45–4.17]; and cerebrovascular disease (RR, 4.39 [95% CI, 3.75–5.13]).

Counties with greater social vulnerability had higher diabetes‐related CVD mortality, especially among younger adults. Targeted health policies that are designed to reduce these disparities are warranted.

Journal Article Type Article
Acceptance Date Sep 13, 2023
Online Publication Date Oct 18, 2023
Deposit Date Oct 30, 2023
Journal Journal of the American Heart Association
Publisher Wiley Open Access
Peer Reviewed Peer Reviewed
Volume 12
Issue 21
Article Number e029649
Keywords Cardiology and Cardiovascular Medicine