Social and Environmental Determinants of Health and Cardio-Kidney-Metabolic Syndrome–Related Mortality
Pedro Rafael Vieira de Oliveira Salerno, Antoinette Cotton, Yakov Elgudin, Salim S. Virani, Khurram Nasir, Ian J. Neeland, Sanjay Rajagopalan, Naveed Sattar, Sadeer Al‐Kindi, Salil V. Deo
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.