{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T17:16:13Z","timestamp":1783098973063,"version":"3.54.6"},"reference-count":61,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"21","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2023,11,7]]},"abstract":"<jats:sec sec-type=\"background\" xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">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\u2010related CVD mortality.<\/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\">County\u2010level 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\u20132019) 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\u2010year study period, 387\u2009139 crude diabetes\u2010related cardiovascular mortality records were identified. The age\u2010adjusted mortality rate for CVD was higher in the fourth quartile compared with the first quartile (relative risk [RR], 1.66 [95% CI, 1.64\u20131.67]) with an estimated 39\u2009328 excess deaths. Among the youngest age group (&lt;55\u2009years), 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\u20132.17]; heart failure (RR, 3.03 [95% CI, 2.62\u20133.52]); hypertensive disease (RR, 3.79 [95% CI, 3.45\u20134.17]; and cerebrovascular disease (RR, 4.39 [95% CI, 3.75\u20135.13]).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Counties with greater social vulnerability had higher diabetes\u2010related CVD mortality, especially among younger adults. Targeted health policies that are designed to reduce these disparities are warranted.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.123.029649","type":"journal-article","created":{"date-parts":[[2023,10,18]],"date-time":"2023-10-18T10:29:05Z","timestamp":1697624945000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":11,"title":["Impact of Social Vulnerability on Diabetes\u2010Related Cardiovascular Mortality in the United States"],"prefix":"10.1161","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8256-5168","authenticated-orcid":false,"given":"Hussein","family":"Bashar","sequence":"first","affiliation":[{"name":"Faculty of Medicine University of Southampton Southampton United Kingdom"},{"name":"Department of Cardiology University Hospital Southampton NHS Foundation Trust Southampton United Kingdom"},{"name":"Keele Cardiovascular Research Group, Centre for Prognosis Research Institute for Primary Care and Health Sciences, Keele University Keele United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7418-498X","authenticated-orcid":false,"given":"Ofer","family":"Kobo","sequence":"additional","affiliation":[{"name":"Keele Cardiovascular Research Group, Centre for Prognosis Research Institute for Primary Care and Health Sciences, Keele University Keele United Kingdom"},{"name":"Department of Cardiology Hillel Yaffe Medical Centre Hadera Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2343-7099","authenticated-orcid":false,"given":"Kamlesh","family":"Khunti","sequence":"additional","affiliation":[{"name":"Diabetes Research Centre University of Leicester Leicester United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8741-3411","authenticated-orcid":false,"given":"Amitava","family":"Banerjee","sequence":"additional","affiliation":[{"name":"Institute of Health Informatics, University College London London United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8167-5760","authenticated-orcid":false,"given":"Renee P.","family":"Bullock\u2010Palmer","sequence":"additional","affiliation":[{"name":"Department of Cardiology Deborah Heart and Lung Center Browns Mills NJ United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9651-7829","authenticated-orcid":false,"given":"Nick","family":"Curzen","sequence":"additional","affiliation":[{"name":"Faculty of Medicine University of Southampton Southampton United Kingdom"},{"name":"Department of Cardiology University Hospital Southampton NHS Foundation Trust Southampton United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9241-8890","authenticated-orcid":false,"given":"Mamas A.","family":"Mamas","sequence":"additional","affiliation":[{"name":"Keele Cardiovascular Research Group, Centre for Prognosis Research Institute for Primary Care and Health Sciences, Keele University Keele United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","unstructured":"National diabetes statistics report . 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