{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T08:55:36Z","timestamp":1791276936473,"version":"4.1.0"},"reference-count":25,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"15","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2022,8,2]]},"abstract":"<jats:sec sec-type=\"background\" xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Social and environmental factors play an important role in the rising health care burden of cardiovascular disease. The Centers for Disease Control and Prevention developed the Social Vulnerability Index (SVI) from US census data as a tool for public health officials to identify communities in need of support in the setting of a hazardous event. SVI (ranging from a least vulnerable score of 0 to a most vulnerable score of 1) ranks communities on 15 social factors including unemployment, minoritized groups status, and disability, and groups them under 4 broad themes: socioeconomic status, housing and transportation, minoritized groups, and household composition. We sought to assess the association of SVI with self\u2010reported prevalent cardiovascular comorbidities and atherosclerotic cardiovascular disease (ASCVD).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">We performed a retrospective cohort analysis of adults (\u226518\u2009years) in the Behavioral Risk Factor Surveillance System 2016 to 2019. Data regarding self\u2010reported prevalent cardiovascular comorbidities (including diabetes, hypertension, hyperlipidemia, smoking, substance use), and ASCVD was captured using participants' response to a structured telephonic interview. We divided states on the basis of the tertile of SVI (first\u2014participant lives in the least vulnerable group of states, 0\u20130.32; to third\u2014participant lives in the most vulnerable group of states, 0.54\u20131.0). Multivariable logistic regression models adjusting for age, race and ethnicity, sex, employment, income, health care coverage, and association with federal poverty line were constructed to assess the association of SVI with cardiovascular comorbidities. Our study sample consisted of 1\u2009745\u2009999 participants \u226518\u2009years of age. States in the highest (third) tertile of social vulnerability had predominantly Black and Hispanic adults, lower levels of education, lower income, higher rates of unemployment, and higher rates of prevalent comorbidities including hypertension, diabetes, chronic kidney disease, hyperlipidemia, substance use, and ASCVD. In multivariable logistic regression models, individuals living in states in the third tertile of SVI had higher odds of having hypertension (odds ratio (OR), 1.14 [95% CI, 1.11\u20131.17]), diabetes (OR, 1.12 [95% CI, 1.09\u20131.15]), hyperlipidemia (OR, 1.09 [95% CI, 1.06\u20131.12]), chronic kidney disease (OR, 1.17 [95% CI, 1.12\u20131.23]), smoking (OR, 1.05 [95% CI, 1.03\u20131.07]), and ASCVD (OR, 1.15 [95% CI, 1.12\u20131.19]), compared with those living in the first tertile of SVI.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">SVI varies across the US states and is associated with prevalent cardiovascular comorbidities and ASCVD, independent of age, race and ethnicity, sex, employment, income, and health care coverage. SVI may be a useful assessment tool for health policy makers and health systems researchers examining multilevel influences on cardiovascular\u2010related health behaviors and identifying communities for targeted interventions pertaining to social determinants of health.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.121.024414","type":"journal-article","created":{"date-parts":[[2022,7,29]],"date-time":"2022-07-29T11:21:32Z","timestamp":1659093692000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":114,"title":["Association Between Social Vulnerability Index and Cardiovascular Disease: A\u00a0Behavioral Risk Factor Surveillance System Study"],"prefix":"10.1161","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7265-380X","authenticated-orcid":false,"given":"Vardhmaan","family":"Jain","sequence":"first","affiliation":[{"name":"Department of Internal Medicine Cleveland Clinic Foundation Cleveland OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6933-790X","authenticated-orcid":false,"given":"Mahmoud","family":"Al Rifai","sequence":"additional","affiliation":[{"name":"Section of Cardiology and Cardiovascular Research, Department of Medicine Baylor College of Medicine Houston TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1559-6911","authenticated-orcid":false,"given":"Safi U.","family":"Khan","sequence":"additional","affiliation":[{"name":"Department of Cardiology Houston Methodist DeBakey Heart &amp; Vascular Center Houston TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0080-1660","authenticated-orcid":false,"given":"Ankur","family":"Kalra","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Krannert Cardiovascular Research Center Indiana University School of Medicine Indianapolis IN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5226-0723","authenticated-orcid":false,"given":"Fatima","family":"Rodriguez","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine and the Cardiovascular Institute Stanford University School of Medicine Stanford CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zainab","family":"Samad","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Aga Khan University Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yashashwi","family":"Pokharel","sequence":"additional","affiliation":[{"name":"Section of Cardiovascular Medicine, Department of Medicine Wake Forest Baptist Health Winston\u2010Salem NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arunima","family":"Misra","sequence":"additional","affiliation":[{"name":"Section of Cardiology and Cardiovascular Research, Department of Medicine Baylor College of Medicine Houston TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9417-6370","authenticated-orcid":false,"given":"Laurence S.","family":"Sperling","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine Emory University School of Medicine Atlanta GA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamal S.","family":"Rana","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine Kaiser Permanente Oakland Medical Center Oakland CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4850-0309","authenticated-orcid":false,"given":"Waqas","family":"Ullah","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine Thomas Jefferson University Hospital Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4682-3526","authenticated-orcid":false,"given":"Ankit","family":"Medhekar","sequence":"additional","affiliation":[{"name":"Section of Cardiology and Cardiovascular Research, Department of Medicine Baylor College of Medicine Houston TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9541-6954","authenticated-orcid":false,"given":"Salim S.","family":"Virani","sequence":"additional","affiliation":[{"name":"Section of Cardiology and Cardiovascular Research, Department of Medicine Baylor College of Medicine Houston TX"},{"name":"Section of Health Services Research, Department of Medicine Baylor College of Medicine Houston TX"},{"name":"Section of Cardiology, Michael E. 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