Individual and cumulative effects of social determinants of health on cardiovascular disease: Gender-specific insights from a cross-sectional NHANES study.

Unemployment showed the largest association with prevalent CVD among all individual SDoH indicators in the fully adjusted model.

• Adjusted odds ratio for unemployment and prevalent CVD was AOR = 2.27 (95% CI: 2.01-2.57) in the fully adjusted Model 2.
• This was described as a 'large association' relative to other SDoH indicators examined.
• Analysis was based on 35,781 participants from NHANES 2005-2018.
• Survey-weighted multivariate logistic regression was used to assess associations.

Adverse individual SDoH indicators were associated with higher odds of prevalent CVD.

• Five core SDoH domains were operationalized through eight validated sub-indicators.
• Among individual SDoH indicators, unemployment, low income (PIR < 300%), and food insecurity showed the strongest independent associations with prevalent CVD.
• Associations were assessed using survey-weighted multivariate logistic regression with full covariate adjustment.
• Data were drawn from the nationally representative NHANES survey spanning 2005-2018.

Higher cumulative adverse SDoH burden was independently associated with higher odds of prevalent CVD.

• Cumulative SDoH exposure was constructed from eight validated sub-indicators across five SDoH domains.
• Both individual and cumulative SDoH were independently associated with prevalent CVD in fully adjusted models.
• The cross-sectional sample included 35,781 U.S. adults from NHANES 2005-2018.
• Survey-weighted multivariate logistic regression was used for cumulative SDoH analyses.

Sex-stratified analyses showed some point estimates for SDoH indicators were larger in women than in men, but sex-by-SDoH interaction tests were not statistically significant.

• All P values for sex-by-SDoH interaction tests were greater than 0.05.
• 95% confidence intervals overlapped for many sex-stratified comparisons.
• Sex-stratified analyses were pre-specified and conducted for all eight SDoH sub-indicators.
• The lack of statistically significant interactions suggests the observed sex differences in point estimates may reflect sampling variability rather than true effect modification.

The study used a cross-sectional design with nationally representative NHANES data spanning 2005-2018.

• The analytic sample included 35,781 participants.
• Data were sourced from NHANES survey cycles from 2005 to 2018.
• Survey-weighted analyses were employed to account for the complex sampling design and produce nationally representative estimates.
• Five core SDoH domains were operationalized through eight validated sub-indicators in the analysis.