Yang Chun, Zhang Na, Gao Tiankuo, Zhu Yingxin, Gong Chen, Xu Mingyue, Feng Cuicui
Beijing Anzhen hospital, Capital Medical University, Beijing 100029, China.
Beijing Friendship Hospital, Capital Medical University, Beijing 100053, China.
Prev Med Rep. 2025 Jan 8;50:102967. doi: 10.1016/j.pmedr.2025.102967. eCollection 2025 Feb.
Premature atherosclerotic cardiovascular disease (ASCVD) is a major public health issue, leading to productivity losses and higher healthcare costs. This study examines the association between social determinants of health (SDoH) and premature ASCVD, with a focus on sex differences.
Data on self-reported SDoH based on Healthy People 2030 criteria were obtained from U.S. National Health and Nutrition Examination Surveys (2003-2018). Weighted logistic regression models were used to examine the relationship between SDoH (including eight sub-items and the cumulative number of unfavorable SDoH) and premature ASCVD. Analyses were further stratified by sex.
A total of 40,536 participants aged ≥18 years (19,548 men and 20,888 women) were included in the analysis. The overall prevalence of premature ASCVD was 1756 cases, with a weighted estimate of 7,625,240. Although women had a lower prevalence of premature ASCVD (3.2 % [ = 784] vs. 4.3 % [ = 972]), they exhibited a higher level of unfavorable SDoH compared to men. Logistic regression indicated a 21 % increase in risk for each additional unfavorable SDoH (AOR = 1.21; 95 % CI, 1.16-1.26), and the cumulative number of unfavorable SDoH were positively associated with the odds of developing premature ASCVD (P for trend <0.01). Notably, the impact of unfavorable SDoH was greater in women, revealing significant sex disparities in susceptibility to premature ASCVD.
This study demonstrates that unfavorable SDoH significantly increase the risk of developing premature ASCVD. Furthermore, the cumulative effect of unfavorable SDoH pose a higher risk for women.
早发性动脉粥样硬化性心血管疾病（ASCVD）是一个重大的公共卫生问题，会导致生产力损失和更高的医疗成本。本研究探讨健康的社会决定因素（SDoH）与早发性ASCVD之间的关联，重点关注性别差异。
基于《健康人民2030》标准的自我报告的SDoH数据来自美国国家健康与营养检查调查（2003 - 2018年）。使用加权逻辑回归模型来研究SDoH（包括八个子项目和不利SDoH的累积数量）与早发性ASCVD之间的关系。分析进一步按性别分层。
共有40,536名年龄≥18岁的参与者（19,548名男性和20,888名女性）纳入分析。早发性ASCVD的总体患病率为1756例，加权估计为7,625,240。尽管女性早发性ASCVD的患病率较低（3.2%[ = 784]对4.3%[ = 972]），但与男性相比，她们表现出更高水平的不利SDoH。逻辑回归表明，每增加一个不利的SDoH，风险增加21%（比值比[AOR]=1.21；95%置信区间[CI]，1.16 - 1.26），不利SDoH的累积数量与发生早发性ASCVD的几率呈正相关（趋势P<0.01）。值得注意的是，不利SDoH对女性的影响更大，揭示了早发性ASCVD易感性方面存在显著的性别差异。
本研究表明，不利的SDoH会显著增加发生早发性ASCVD的风险。此外，不利SDoH的累积效应对女性构成更高风险。
