Impacts of social determinant of health on cardiovascular event and mortality risk in community-dwelling population without cardiovascular disease: results of the China PEACE million persons project

Abstract Aim To evaluate the impacts of social determinant of health (SDOH) on major adverse cardiovascular event (MACE) and mortality risk in community-dwelling population. Methods The China PEACE million persons project is a nationwide, government-funded and population-based cardiovascular disease (CVD) screening study. This was a sub-cohort study of the project that included community-dwelling adults free of CVD from Guangdong Province. Metrics of SDOH, including education attainment, economic stability, health care access, social support and environment/neighborhood, were collected using self-report questionnaires. Each favorable metric was assigned 1 point, and individuals with 0-3 points were defined as low SDOH and those with 4-5 points were defined as high SDOH. MACE (including coronary heart disease/myocardial infarction, stroke, heart failure and cardiovascular death) and all-cause death were identified by linking hospital records. Results Among the cohort (n=38571, median age 54 years and women 60.5%), proportion of individuals with low SDOH was 68.9%. After a median follow-up of 3.6 years, compared to the high SDOH group, the low SDOH group had significantly higher event rate of MACE (7.2% vs 5.0%, P<0.001) and all-cause death (1.6% vs 0.9%, P<0.001). After adjusted for covariates, in reference to the high SDOH group, the adjusted hazard ratio (HR) for MACE in the low SDOH group was 1.18 (95% confidence interval [CI] 1.08-1.30) and for all-cause death was 1.35 (95% CI 1.09-1.68). Conclusion Low SDOH was associated with an increased risk of MACE and all-cause death. Concerted efforts are needed to reduce health disparities between individuals with low versus high SDOH.Graphical abstract