Prevention & lipidsCohort study
A novel cumulative social advantage metric for enhancing the cardiovascular health construct and predicting mortality risk
- Prospective cohort study
Authors' conclusion
An enhanced CVH score including SDoH metric strongly predicted mortality among US adults.
Study context
- Population
- US adults aged 20–79y, NHANES 1999–2018
- Participants
- 46,366 adults
- Exposure
- Social advantage metric (SAM) categories and enhanced cardiovascular health (CVH) score vs LE8 alone
- Outcome
- All-cause and CV mortality
Main finding
As reported in the abstract
All-cause and CV mortality by SAM category
Highest vs lowest SAM: 67% lower all-cause and 69% lower CV mortality risk
p-trend<0.001
Highest enhanced CVH category: all-cause mortality HR
0.22(0.14-0.34) (95% CI)
Highest enhanced CVH category: CV mortality HR
0.17(0.07-0.41) (95% CI)
Observational data: associations, not effects.
Further findings
Mean SAM, by race and ethnicity
- Overall mean SAM
- 59
- White
- 66
- Black
- 47
- Hispanic
- 36
Predictive performance (C-statistic), enhanced score vs LE8 alone
- C-statistic enhanced vs LE8 (comparable)
- 0.835 vs. 0.831, p<0.001
Associations by race/ethnicity and sex
- Varied by race and ethnicity, not sex; significant in White and Black but not Hispanic adults
- P for interaction < 0.01
Original publication
A novel cumulative social advantage metric for enhancing the cardiovascular health construct and predicting mortality risk. Eur J Prev Cardiol. Published 1 December 2025. doi:10.1093/eurjpc/zwaf752
Summarised from the published abstract; every number is checked against it