Social Determinants of Health Reveal Heterogeneity in Associations Between American Heart Association (AHA) PREVENT Cardiovascular Disease Risk Equations and Mortality and Provide Incremental Discrimination for Mortality in US Adults
Authors' conclusion
SDOH burden was associated with graded mortality and modified the strength of the association between PREVENT-estimated 10-year CVD risk and mortality. Adding SDOH modestly improved mortality discrimination beyond PREVENT alone
Study context
- Population
- US adults aged 40–75 years, NHANES 2003–2018, linked to National Death Index through December 31, 2019; mean age 54.3 years, 52.6% women
- Participants
- 18,694 adults
- Exposure
- Higher vs lower PREVENT-estimated 10-year cardiovascular disease (CVD) risk, by social determinants of health (SDOH) burden
- Outcome
- All-cause and cardio-cerebrovascular disease (CCD) mortality
- Follow-up
- Median 8.2 years (IQR, 4.3-12.3)
Methodological detailsnationally representative, survey-weighted Cox models, linked to National Death Index
- Nationally representative
- Survey-weighted Cox models
- Linked to National Death Index
Main finding
As reported in the abstract
Mortality per 5-percentage-point higher PREVENT-estimated risk
All-cause mortality, HR
1.55
95% CI 1.47–1.64
Cardio-cerebrovascular disease (CCD) mortality, HR
1.62
95% CI 1.52–1.74
All-cause deaths
1646
CCD deaths
392
Observational data: associations, not effects.
Further findings
| Outcome | 0 unfavourable | ≥ 5 unfavourable | P value |
|---|---|---|---|
| Association of PREVENT risk with mortality by SDOH burden (heterogeneity) | P for interaction < 0.001 for both outcomes | ||
| All-cause HR (95% CI 1.79-2.25) | 2.01 | — not stated in the abstract | |
| CCD HR (95% CI 1.91-2.88) | 2.35 | — not stated in the abstract | |
| All-cause HR (95% CI 1.26-1.50) | — not stated in the abstract | 1.38 | |
| CCD HR (95% CI 1.31-1.62) | — not stated in the abstract | 1.46 |
— not stated in the abstract
- Association of PREVENT risk with mortality by SDOH burden (heterogeneity): results for 1-2 and 3-4 groups not reported in abstract
Discrimination (AUC) after adding SDOH to PREVENT · 10 years
- All-cause AUC, PREVENT vs PREVENT + SDOH (p < 0.001)
- 0.747 to 0.778
- CCD AUC, PREVENT vs PREVENT + SDOH (p = 0.042)
- 0.790 to 0.812
- Time-dependent ROC curves
Original publication
Social Determinants of Health Reveal Heterogeneity in Associations Between AHA PREVENT Cardiovascular Disease Risk Equations and Mortality and Provide Incremental Discrimination for Mortality in US Adults. Diabetes Obes Metab. Published 10 May 2026. doi:10.
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