Social Vulnerability and Premature CVD Mortality

Quick Takes

  • In the United States, counties with higher rates of social vulnerabilities have higher rates of premature CVD mortality among adults under the age of 65 years.
  • Rural counties with social vulnerabilities have higher rates of premature CVD deaths.
  • The impact of social vulnerabilities in US counties varies by gender and race/ethnicity, with middle-aged men and non-Hispanic Blacks experiencing higher rates of CVD mortality.
  • These data will assist public health and policies in addressing county-wide social vulnerabilities to reduce health disparities and associated premature CVD mortality.

Study Questions:

Are social vulnerabilities within US counties associated with premature cardiovascular disease (CVD)?


This cross-sectional study linked county-level social vulnerability index (SVI) data from the Centers for Disease Control and Prevention (CDC) with county-level CDC WONDER (Wide-Ranging Online Data for Epidemiological Research) mortality data for 2014-2018. Scores for overall SVI and four subcomponents (socioeconomic status, household composition, disability, minority status, and language) were calculated using 15 social attributes. Scores were grouped as percentage rank for counties and quartiles from least vulnerable to most vulnerable. Age-adjusted mortality rates were calculated for overall CVD and ischemic heart disease (IHD), stroke, hypertension, and heart failure (HF).


A total of 3,143 US counties were included in the present analysis. Larger concentrations of social vulnerabilities and CVD mortality were located in the Southeastern and Southwestern regions of the United States. Over the 4 years (2014-2018), 607,773 CVD deaths occurred with an age-adjusted mortality rate of 47.0 (IHD 28,3, stroke 7.9, hypertension 8.4, and HF 2.4). Age-adjusted mortality for IHD was 28.1 (95% confidence interval [CI], 28.2-28.4), for stroke 7.9 (95% CI, 7.8-8.0), for hypertension 8.4 (95% CI, 8.4-8.5), and for HF 2.4 (95% CI, 2.3-2.5). Age-adjusted CVD mortality rates were higher among middle-aged adults, men, and non-Hispanic Black adults compared to the other groups. Rural counties had higher CVD mortality rates compared to urban counties. CVD mortality rates increased from least vulnerable to most vulnerable counties. CVD relative risk (RR) was 1.84 (95% CI, 1.43-2.36) for counties in the top quartile for social vulnerability (SVI score) compared to the least vulnerable counties. Similar results were observed for IHD (RR, 1.52 [1.09-2.13]), stroke (RR, 2.03 [1.12-3.70]), hypertension (RR, 2.71 [1.54-4.75]), and HF (RR, 3.38 [1.32-8.61]). Non-Hispanic Black adults in fourth versus first SVI quartile exclusively had significantly higher RRs of stroke (1.65 [1.07-2.54]) and HF (2.42 [1.29-4.55]) mortality. Rural counties with more social vulnerabilities had two- to five-fold higher mortality due to CVD and subtypes.


In this analysis, the investigators concluded that US counties with more social vulnerabilities had higher premature CVD mortality, and varied by demographic characteristics and rurality. Therefore, focused public health interventions should address the socioeconomic disparities faced by underserved communities to curb the growing burden of premature CVD.


These data support prior evidence suggesting that health disparities are disproportionately experienced in areas where higher degrees of social vulnerability exist, and highlights the impact of social vulnerabilities on racial/ethnic groups and rural residents in the US. The data from this present study and others can inform public health policies and programs that target social factors in communities with the goal to reduce disparities in CVD prevention.

Clinical Topics: Cardiovascular Care Team, Heart Failure and Cardiomyopathies, Prevention, Acute Heart Failure, Hypertension

Keywords: Cardiovascular Diseases, Disability Studies, Ethnic Groups, Health Policy, Heart Failure, Hypertension, Mortality, Premature, Myocardial Ischemia, Primary Prevention, Public Health, Risk, Social Class, Social Factors, Stroke, Vascular Diseases

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