Social Determinants of Health, Depression, and Cardiovascular Health Among Veterans and Civilians: Insights From the 2013-2018 and 2021-2023 National Health and Nutrition Examination Survey.

Veterans had lower mean cardiovascular health scores than civilians as measured by Life's Essential 8.

• Mean cardiovascular health score was 67 among veterans compared to 71 among civilians.
• Life's Essential 8 scoring metric ranges from 0 to 100, with higher scores indicating better health status.
• The study included 926 veterans and 10,470 civilians among 11,396 total participants.
• Veterans had a mean age of 56 years compared to 46 years for civilians.
• Veterans were approximately 90% male (10% female) versus 45% male (55% female) for civilians.

Poorer cardiovascular health was associated with older age, non-Hispanic Black or multiracial identity, lower education, lower financial status, and depression symptoms in both civilians and veterans.

• These associations were identified using multiple linear regressions with sample weights applied.
• Depression was assessed using the Patient Health Questionnaire-9, dichotomized as scores 0–5 (no depression) versus 5 or more (mild to severe depression).
• The finding was consistent across both the veteran and civilian groups.
• Cross-sectional data from 2013–2018 and 2021–2023 NHANES cycles were used.
• All participants were aged 20 years or older and without pre-existing cardiovascular disease.

The associations between cardiovascular health and social determinants of health were more pronounced among veterans who identify as racial or ethnic minority members or have lower financial status.

• Associations were described as 'more pronounced among veterans who identify as members of racial and ethnic minority populations or have lower financial status.'
• This suggests an interaction or effect modification by veteran status on the relationship between social determinants of health and cardiovascular health.
• The finding points to compounded disadvantage for veterans who also face racial/ethnic minority status or financial hardship.
• Non-Hispanic Black identity and 'other' or multiracial identity were specifically identified as factors linked to poorer cardiovascular health.

Veterans were more likely than civilians to have some college education, higher financial status, and access to health care.

• Despite these socioeconomic advantages, veterans still had lower mean cardiovascular health scores (67 vs. 71).
• This suggests that socioeconomic advantages did not fully offset other cardiovascular health risk factors among veterans.
• Social determinants of health examined included demographic characteristics, socioeconomic factors, and access to health care.
• The veteran sample comprised 926 participants from the 2013–2018 and 2021–2023 NHANES datasets.

The study found that the magnitude of links between cardiovascular health and certain social determinants of health varied by veteran status.

• This variation indicates that 'varied factors may influence health disparities in each group.'
• The authors conclude this underscores 'the need for tailored strategies to address' disparities in veterans versus civilians.
• Cross-sectional design limits causal inference; the study relied on self-reported veteran status from NHANES.
• The study excluded participants with pre-existing cardiovascular disease, focusing on primary prevention populations.

Veterans have a disproportionate prevalence of cardiovascular disease, depression, and social determinants of health concerns related to socioeconomic status and healthcare access.

• This background context motivated the study's focus on comparing social determinants of health and depression symptom associations between veterans and civilians.
• Veterans face 'challenges with access to healthcare' despite federal veterans' health systems.
• Emerging evidence supports the relationship among social determinants of health, depression symptoms, and cardiovascular health.
• The study aimed to assess whether associations of social determinants of health and depression with cardiovascular health differed between veterans and civilians.