Mediating Effect of Established Risk Factors on Association Between Social Determinants and Cardiovascular Disease Mortality
Authors' conclusion
Behavioral and clinical risk factors partially mediate the association between unfavorable SDOH and increased CVD mortality.
Study context
- Population
- National Health and Nutrition Examination Survey participants aged ≥20 yearsNational Health and Nutrition Examination Survey participants, mean age 47.2 years, 48.8% male
- Participants
- 50,808 participants
- Comparison
- Composite social determinants of health (SDOH) score ≥ median vs < median, with mediation by behavioral and clinical risk factors
- Outcome
- CVD mortality by number of SDOH
Methodological detailslinkage to the National Death Index with follow-up through 2019
- Linkage to the National Death Index with follow-up through 2019
Main finding
As reported in the abstract
- A dose-response association between the number of SDOH and cardiovascular disease (CVD) mortality was identified
Further findings
| Outcome | HR (95% CI) | |
|---|---|---|
| CVD mortalityComposite SDOH score ≥ medianvs score < median2.13-fold increased risk | 2.13 (1.91–2.37) | |
| CVD mortalityComposite SDOH score ≥ medianvs score < medianAfter adjusting for behavioral and clinical risk factors | 1.67 (1.50–1.86) | |
| 0.512Hazard ratio (log scale) |
Relative contribution of individual mediators to the SDOH-CVD mortality association
- Current smoking
- 11.4%; 95% CI: 8.1%-14.8%
- Physical inactivity
- 7.7%; 95% CI: 4.9%-10.6%
- Chronic kidney disease
- 5.5%; 95% CI: 3.8%-7.1%
- Diabetes
- 2.0%; 95% CI: 1.1%-2.9%
- Unhealthy sleep duration
- 1.8%; 95% CI: 0.3%-3.3%
- Significantly mediated
Aggregate mediation by behavioral and clinical risk factors
- Proportion of overall CVD mortality attributable to unfavorable SDOH mediated
- 30.8% (95% CI: 24.2%-37.5%)
Original publication
Mediating Effect of Established Risk Factors on Association Between Social Determinants and Cardiovascular Disease Mortality. JACC Adv. Published 8 May 2025. doi:10.
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