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. 2024 Sep 3;7(9):e2435783.
doi: 10.1001/jamanetworkopen.2024.35783.

Social and Environmental Determinants of Health and Cardio-Kidney-Metabolic Syndrome-Related Mortality

Pedro Rafael Vieira de Oliveira Salerno  1 , Antoinette Cotton  2 , Yakov E Elgudin  1   2   3 , Salim Virani  4   5   6 , Khurram Nasir  7 , Ian Neeland  1   2 , Sanjay Rajagopalan  1   2 , Naveed Sattar  8 , Sadeer Al-Kindi  7 , Salil V Deo  2   3   9
Affiliations

Social and Environmental Determinants of Health and Cardio-Kidney-Metabolic Syndrome-Related Mortality

Pedro Rafael Vieira de Oliveira Salerno et al. JAMA Netw Open. .

Abstract

Importance: It is not well understood if and how various social and environmental determinants of health (SEDoH) are associated with mortality rates related to cardio-kidney-metabolic syndrome (CKM) across the US.

Objective: To study the magnitude of the association strength of SEDoH with CKM-related mortality at the county level across the US.

Design, setting, and participants: This cross-sectional, retrospective, population-based study used aggregate county-level data from the US Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (WONDER) data portal from 2010-2019. Data analysis occurred from September 2023 to January 2024.

Exposures: A total of 7 diverse SEDoH were chosen, including median annual household income, percentage of racial and ethnic minority residents per county, fine particulate air pollution (PM2.5) concentrations, high-school completion rate, primary health care access, food insecurity, and rurality rate.

Main outcomes and measures: The primary outcome was county-level age-adjusted mortality rate (aaMR) attributable to CKM. The association of county-level CKM-related aaMR with the 7 SEDoH was analyzed using geographically weighted models and the model median coefficients for each covariate studied.

Results: Data from 3101 of 3243 counties (95.6%) were analyzed. There was substantial variation in SEDoH between states and counties. The overall pooled median (IQR) aaMR (2010-2019) in the US was 505.5 (441.3-578.9) per 100 000 residents. Most counties in the lower half of the US had rates much higher than the pooled median (eg, Southern US median [IQR] aaMR, 537.3 [466.0-615.9] per 100 000 residents). CKM-related mortality was positively associated with the food insecurity rate (median [IQR] β = 6.78 [2.78-11.56]) and PM2.5 concentrations (median [IQR] β = 5.52 [-11.06 to 19.70]), while it was negatively associated with median annual household income (median [IQR] β = -0.002 [-0.003 to -0.001]), rurality (median [IQR] β = -0.32 [-0.67 to 0.02]), high school completion rate (median [IQR] β = -1.89 [-4.54 to 0.10]), racial and ethnic minority rate (median [IQR] β = -0.66 [-1.85 to 0.89]), and primary health care access rate (median [IQR] β = -0.18 [-0.35 to 0.07]).

Conclusions and relevance: In this cross-sectional study of county-level data across the US, there were substantial geographical differences in the magnitude of the association of SEDoH with CKM-related aaMR. These findings may provide guidance for deciding local health care policy.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Virani reported receiving grants from the Department of Veterans Affairs, National Institutes of Health, UK National Institute for Health and Care Research, and Tahir and Jooma Family (research grants in the areas of cardiovascular diseases and cardiometabolic diseases) and travel support from the American College of Cardiology to serve as faculty for the Emerging Faculty Leadership Academy program in Washington, DC (2023-2024) outside the submitted work. Dr Sattar reported receiving personal fees from Abbott Laboratories, AbbVie, Amgen, AstraZeneca, Boehringer Ingelheim, Eli Lilly, Hanmi Pharmaceuticals, Janssen, Menarini-Ricerche, Novartis, Novo Nordisk, Pfizer, Roche Diagnostics, and Sanofi; grants from AstraZeneca, Boehringer Ingelheim, Novartis, and Roche Diagnostics outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Social and Environmental Determinants of Health Included in the Study
In this panel of maps, we presented the county-level values for the 7 social and environmental determinants of health across the US. Gray colored counties indicate counties where data is not available. Readers should evaluate these maps in conjunction with eFigures 1 to 7 in Supplement 1 that report these observations for each US State and Washington, DC. PM2.5 indicates fine particulate matter air pollution (<2.5 µg/m3).
Figure 2.
Figure 2.. County-Level Cardio-Kidney-Metabolic Syndrome–Attributable All-Cause Mortality Across the US
Gray colored counties indicate counties where data is not available.
Figure 3.
Figure 3.. Coefficients for Each Social and Environmental Determinant of Health Included in the Geographically Weighted Regression Model
In this panel of maps, we present the results of the multivariable geographically weighted linear regression model fitted to explore the association of county-level cardio-kidney-metabolic syndrome–related all-cause mortality rate and the studied social and environmental determinants of health. We have presented the coefficient for each county for each exposure included in our geographically weighted linear regression model. Gray colored counties indicate counties where data is not available. These maps should be studied along with the P values reported for each county for each exposure, which are presented in eFigure 8 in Supplement 1.
See this image and copyright information in PMC

References

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