{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T11:02:36Z","timestamp":1790766156383,"version":"4.1.0"},"reference-count":37,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Chronic Diseases and Translational Medicine"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Cardiovascular disease (CVD) is the leading cause of death in the United States. We examined whether a model that classifies prevalent CVD using clinical risk factor precursors (social, environmental, and behavioral factors), age, and sex, organized according to the Vital Conditions for Health framework, demonstrates good discrimination and calibration.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In this cross\u2010sectional study, we analyzed the 2021 Medical Expenditure Panel Survey (MEPS) Social Determinants of Health (SDOH) dataset (\n                      <jats:italic>N<\/jats:italic>\n                      \u2009=\u200918,435 adults). Cardiovascular disease prevalence was defined using self\u2010reported diagnoses and International Classification of Diseases, 10th Revision (ICD\u201010), codes. Candidate predictors included variables from the seven Vital Conditions domains, age, and sex. Models included least absolute shrinkage and selection operator (LASSO) regression and extreme gradient boosting (XGBoost). Internal validation used stratified k\u2010fold cross\u2010validation and 2022 MEPS data. Discrimination and calibration were assessed using the area under the receiver operating characteristic curve (AUC), Brier score, calibration slope, calibration\u2010in\u2010the\u2010large (CITL), and observed\u2010to\u2010expected (O:E) ratio. Subgroup performance was evaluated by age, sex, and race or ethnicity.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Both LASSO and XGBoost performed well. LASSO achieved an AUC of 0.822 (95% confidence interval [CI], 0.815\u20130.831), with a calibration slope of 1.022 and an O:E ratio of 1.001. XGBoost achieved an AUC of 0.822 (95% CI, 0.814\u20130.831), with a calibration slope of 1.026 and an O:E ratio of 1.002. Discrimination was stable across sex and race or ethnicity subgroups, although some calibration drift occurred among Hispanic participants. Performance declined among adults aged \u2265\u200965 years (XGBoost AUC, 0.67) compared with those aged &lt;\u200965 years (AUC, 0.812). Key predictors included age, sex, exercise, social isolation, healthcare access, food insecurity, financial strain, adverse childhood experiences (ACEs), smoking, and transportation barriers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Models using upstream social determinants of health, age, and sex demonstrated good discrimination when classifying prevalent CVD. External and prospective validation is needed before these models can be considered for clinical or population\u2010level screening.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cdt3.70069","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T10:22:23Z","timestamp":1790763743000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prediction of Prevalent Cardiovascular Disease Using Social, Environmental, and Behavioral Factors: A Vital Conditions Framework Approach"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0933-4472","authenticated-orcid":false,"given":"Stephanie","family":"Kjelstrom","sequence":"first","affiliation":[{"name":"College of Population Health Thomas Jefferson University Philadelphia Pennsylvania USA"},{"name":"Lankenau Institute for Medical Research Wynnewood Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Hass","sequence":"additional","affiliation":[{"name":"College of Population Health Thomas Jefferson University Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Vollbrecht","sequence":"additional","affiliation":[{"name":"Brown University Providence Rhode Island USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brandon","family":"George","sequence":"additional","affiliation":[{"name":"College of Population Health Thomas Jefferson University Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharon","family":"Larson","sequence":"additional","affiliation":[{"name":"College of Population Health Thomas Jefferson University Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,30]]},"reference":[{"issue":"30","key":"e_1_2_12_2_1","first-page":"649","article-title":"Achievements in Public Health, 1900\u20101999: Decline in Deaths From Heart Disease and Stroke \u2010\u2010 United States, 1900\u20101999","volume":"48","author":"Centers for Disease Control and Prevention","year":"1999","journal-title":"Morbidity and Mortality Weekly Report"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001209"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2023.11.009"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.1920391117"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2015.08.024"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2008.792"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.88.4.1973"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.123.064215"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1177\/0013916518814291"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.5888\/pcd20.230098"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1161\/HCQ.0000000000000089"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCRESAHA.121.319811"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.122.027919"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/PSY.0000000000000022"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.82.6.816"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000228"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/spc3.12087"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2017.06.044"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1136\/jech.49.1.10"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.97.18.1837"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehab309"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2362.2007.01888.x"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.123.067626"},{"key":"e_1_2_12_25_1","unstructured":"B.Milstein B.Payne C.Kelleher et al. \u201cOrganizing Around Vital Conditions Moves the Social Determinants Agenda into Wider Action \u201d Health Affairs Forefront February 2 2023 doi; 10.1377\/forefront.20230131.673841.https:\/\/www.healthaffairs.org\/content\/forefront\/organizing-around-vital-conditions-moves-social-determinants-agenda-into-wider-action."},{"key":"e_1_2_12_26_1","unstructured":"Agency for Healthcare Research and Quality \u201cMEPS HC\u2010233 2021 Full Year Consolidated Data File \u201d 2021 accessed January 18 2024 https:\/\/meps.ahrq.gov\/data_stats\/download_data\/pufs\/h233\/h233doc.shtml#Definition362."},{"key":"e_1_2_12_27_1","unstructured":"L.Blewett J. 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