A high social vulnerability index (SVI) score was associated with worse cardiovascular disease outcomes, including premature cardiovascular death, according to results from a scoping review published March 6 in JACC: Advances.

The SVI, developed by the Centers for Disease Control and Prevention, provides granular data on 16 social variables in communities (county, census-level tracts) across four domains of social determinants of health (SDOH): socioeconomic status, household characteristics, racial and ethnic minority status, and housing type and transportation.

Ramzi Ibrahim, MD, et al., conducted the scoping review to identify gaps in understanding of the impact of the SVI on cardiovascular disease and to determine areas of future research. Through a systematic search of seven databases through May 19, 2023, they identified 12 studies that examined mortality outcomes, risk factor prevalence, cardiovascular disease prevalence, health care access, use of cardiac rehabilitation, and heart failure readmission rates.

Results showed that in all the studies a greater SVI score was significantly associated with multiple components of the cardiovascular disease continuum. Along with increased premature cardiovascular death and cardio-oncology-related death, they found a higher likelihood of dying from heart failure at home or an inpatient facility vs. a nursing home, decreased access to health care and cardiac rehabilitation, increased risk of cardiovascular disease and prevalence of coronary heart disease, and more readmissions.

The authors write that they demonstrated the versatility of the SVI as a comprehensive metric of social vulnerability. Furthermore, they identified gaps in understanding, mostly related to prevention, early detection and effectiveness of treatment options for cardiovascular disease. They note the need longitudinal studies to explore how changes in SVI impact cardiovascular disease outcomes over time.

“These findings aim to empower population-health researchers to identify these missing components of SVI in the cardiovascular disease care continuum,” write the researchers.

“We continue to live in a time where an individual’s zip code can dictate health outcomes,” Jamal S. Rana, MD, PhD, FACC,and Isaac Acquah, MD, MPH, write in an accompanying editorial comment. “Their consistent finding of an association between the SVI and various aspects of cardiovascular disease across all 12 studies reviewed underscores the persistent role of SDOH in perpetuating health inequities and disease burden among vulnerable populations,” they add. “Notably, this research extends the SVI’s original purpose of identifying communities needing support during disasters to encompass cardiovascular disease as a critical public health concern.”