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Socioeconomic Deprivation and Premature Cardiovascular Mortality in the United States

  • Graham H. Bevan
    Affiliations
    Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA

    School of Medicine, Case Western Reserve University, Cleveland, OH, USA
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  • Khurram Nasir
    Affiliations
    Center for Cardiovascular Outcomes, Houston Methodist, Houston, TX, USA
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  • Sanjay Rajagopalan
    Affiliations
    Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA

    School of Medicine, Case Western Reserve University, Cleveland, OH, USA
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  • Sadeer Al-Kindi
    Correspondence
    Correspondence: Address to Sadeer Al-Kindi, MD, Harrington Heart and Vascular Institute, University Hospitals, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44106 USA.
    Affiliations
    Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA

    School of Medicine, Case Western Reserve University, Cleveland, OH, USA
    Search for articles by this author

      Abstract

      Objective

      To determine the variability in county cardiovascular (CV) premature mortality explained by integrated metrics of socioeconomic deprivation and to explore temporal trends in CV mortality by county socioeconomic deprivation.

      Methods

      This is a cross-sectional analysis of US county-level death certificate data from 1999 to 2018 of age-adjusted premature (25 to 64 years) CV mortality. Integrated metrics of socioeconomic deprivation (Social Deprivation Index [SDI] and county Area Deprivation Index [ADI]) were associated with mortality using linear regression analysis. Relative change in county CV mortality from 1999 to 2018 was associated with indices using linear regression analysis.

      Results

      Counties with higher quartile SDI and ADI had significantly higher total, non-Hispanic Black/African American, and female premature CV mortality (P<.001). Both SDI and ADI were significantly associated with CV mortality by linear regression (P<.001) explaining 40% and 44% of county variability in CV mortality, respectively. Counties with lower deprivation indices experienced a larger decreased in premature CV mortality (P<.001).

      Conclusion

      This study demonstrates an association between multiple integrated metrics of socioeconomic deprivation and premature cardiovascular mortality and shows potentially worsening disparities.
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