# Individual and cumulative effects of social determinants of health on cardiovascular disease: Gender-specific insights from a cross-sectional NHANES study

## TL;DR

This study explores how social factors like unemployment and income affect heart disease in U.S. adults, with some differences observed between men and women.

## Contribution

The study provides gender-specific insights into how individual and cumulative social determinants of health relate to cardiovascular disease.

## Key findings

- Unemployment was strongly linked to higher odds of cardiovascular disease.
- Sex-stratified analyses showed larger point estimates in women, but differences were not statistically significant.
- Cumulative adverse social determinants were associated with increased cardiovascular disease prevalence.

## Abstract

This study aimed to examine the associations of individual and cumulative social determinants of health (SDoH) with cardiovascular disease (CVD) prevalence and sex-specific disparities among U.S. adults.

Employing a cross-sectional design, we analyzed data from the nationally representative National Health and Nutrition Examination Survey (NHANES, 2005–2018). Five core SDoH domains were operationalized through eight validated sub-indicators. Associations between individual and cumulative SDoH and CVD prevalence were assessed using survey-weighted multivariate logistic regression, with sex-stratified analyses.

In this cross-sectional sample of 35,781 participants, adverse individual SDoH and higher cumulative adverse SDoH were associated with higher odds of prevalent CVD. In the fully adjusted model (Model 2), unemployment showed a large association with prevalent CVD (AOR = 2.27, 95% CI: 2.01–2.57). In sex-stratified analyses, point estimates for some SDoH indicators were higher in women than in men, but 95% confidence intervals overlapped for many comparisons and sex-by-SDoH interaction tests were not statistically significant (all P for interaction > 0.05). Among individual SDoH indicators, unemployment and low income (PIR < 300%), as well as food insecurity, showed the strongest independent associations with prevalent CVD.

Both individual and cumulative SDoH were independently associated with prevalent CVD. Sex-stratified analyses suggested that some point estimates were larger in women than in men, but sex-by-SDoH interaction tests were not statistically significant.