Brush John E, Kim Chungsoo, Liu Yuntian, Xin Xin, Huang Chenxi, Lundy Iris J, Asher Jordan R, Sawano Mitsuaki, Young Patrick, McPadden Jacob, Anderson Mark, Burrows John S, Krumholz Harlan M, Lu Yuan
Sentara Health Research Center, Sentara Health, Norfolk, Virginia, USA; Macon & Joan Brock Virginia Health Sciences at Old Dominion University, Norfolk, Virginia, USA.
Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut, USA; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA.
JACC Adv. 2025 Jul 7;4(8):101912. doi: 10.1016/j.jacadv.2025.101912.
Neighborhood-level social vulnerability is associated with hypertension prevalence and severity and with cardiovascular complications in conditions other than hypertension, but its association with cardiovascular complications in patients with hypertension is understudied.
The aim of the study was to examine how the neighborhood-level social vulnerability index (SVI) influences cardiovascular outcomes in a large, diverse cohort of patients with hypertension.
We used electronic health data to examine the association between census tract-level rankings for the SVI with a composite endpoint of incident myocardial infarction, congestive heart failure, or stroke.
In a longitudinal cohort of 330,972 patients with hypertension followed for a median of 6.6 years, the neighborhood-level SVI was significantly associated with the composite endpoint after adjustment for demographics, baseline body mass index and blood pressure (BP), and comorbidities (HR for quartile 4 [most disadvantaged group] vs quartile 1 = 1.31 [95% CI: 1.25-1.38], P < 0.001). Patients living in quartile 4 SVI areas had a significantly lower BP control rate compared with patients living in quartile 1 SVI areas (70.3% vs 74.8%, P < 0.001). Patients living in SVI quartile 4 areas were disproportionately Black (53.8%). Compared with the White race, the Black race was negatively associated with the composite outcome after adjustment for the SVI quartile, and other clinical factors (HR: 0.89 [95% CI: 0.86-0.92], P < 0.001).
Neighborhood-level social vulnerability was strongly associated with adverse cardiovascular outcomes and poorer BP control and may be a driver of racial disparities in hypertension. These findings highlight the potential of leveraging social vulnerability indices for tailored interventions in hypertension management.
社区层面的社会脆弱性与高血压患病率及严重程度相关，也与高血压以外疾病的心血管并发症相关，但它与高血压患者心血管并发症之间的关联研究较少。
本研究旨在探讨社区层面的社会脆弱性指数（SVI）如何影响一个大型、多样化的高血压患者队列的心血管结局。
我们使用电子健康数据来研究SVI在人口普查区层面的排名与心肌梗死、充血性心力衰竭或中风等复合终点之间的关联。
在一个纵向队列中，330972名高血压患者的中位随访时间为6.6年，在对人口统计学、基线体重指数和血压（BP）以及合并症进行调整后，社区层面的SVI与复合终点显著相关（第4四分位数[最弱势群体]与第1四分位数的风险比=1.31[95%CI：1.25-1.38]，P<0.001）。与居住在SVI第1四分位数区域的患者相比，居住在SVI第4四分位数区域的患者血压控制率显著更低（70.3%对74.8%，P<0.001）。居住在SVI第4四分位数区域的患者中黑人比例过高（53.8%）。在对SVI四分位数和其他临床因素进行调整后，与白人种族相比，黑人种族与复合结局呈负相关（风险比：0.89[95%CI：0.86-0.92]，P<0.001）。
社区层面的社会脆弱性与不良心血管结局及较差的血压控制密切相关，可能是高血压种族差异的一个驱动因素。这些发现凸显了利用社会脆弱性指数进行高血压管理针对性干预的潜力。
