Gohar, Najam

Background: Coronary heart disease (CHD) remains the leading cause of death in the United States, yet the benefits of modern cardiovascular care are not equitably distributed. Social determinants of health (SDoH), which includes economic stability, education, healthcare access, and neighborhood environment, may substantially shape outcomes among patients with CHD. Our study evaluates the joint association of SDoH burden and CHD with mortality outcomes. Methods: We analyzed adults ≥20 years from the National Health and Nutrition Examination Survey (NHANES) 2000–2018, linked with the National Death Index through 2018. Cumulative SDoH burden was derived from eight domains (employment, poverty-to-income ratio, food insecurity, education, healthcare access, insurance, housing, marital status), categorized as low (0–2), moderate (3–5), or high (6–8). Weighted Cox proportional hazards models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause and cardiovascular mortality by SDoH burden, stratified by CHD status, with sequential adjustment for demographic and cardiometabolic factors. Results: Among 49.3 million U.S. adults (mean age 46.1 ± 15.6 years; 44.8% female), 3.7% had CHD. Those with CHD were older (64.7 vs 45.4 years, p < 0.001), more often non-Hispanic White (94.2% vs 81.5%), and had greater waist circumference (106.1 vs 87.5 cm) but lower cholesterol (176 vs 202 mg/dL, p < 0.001). Participants with high SDoH burden had lower income and education. In weighted regression, higher SDoH burden and CHD were independently associated with greater all-cause and cardiovascular mortality. Fully adjusted models showed high SDoH burden tripled all-cause mortality risk (HR 3.00, p < 0.001), while CHD further amplified risk. Compared with low SDoH/no CHD, those with CHD and high SDoH burden had nearly a 14-fold higher all-cause mortality (HR 13.6, p < 0.001) and 17-fold higher cardiovascular mortality (HR 17.7, p < 0.001). Findings were consistent across sex, race, and metabolic subgroups, with mortality hazards often exceeding tenfold among those with both CHD and high SDoH burden. Conclusions: Cumulative SDoH burden is strongly and independently associated with mortality among adults with CHD, with evidence of a synergistic effect between biological and social vulnerability. These findings underscore the need for policies and interventions addressing upstream social inequities to improve survival in cardiovascular populations.

Abstract Background Valvular heart disease (VHD) and atrial fibrillation (AF) frequently coexist, presenting complex clinical challenges despite advances in diagnostics and therapeutics. Together, they contribute substantially to cardiovascular mortality. However, epidemiological patterns vary across demographics and regions Methods Mortality data from 1999–2023 were obtained from the CDC WONDER database. Deaths attributed to VHD (ICD-10: I30-I52) with co-diagnosed AF (ICD-10: I48) among adults ≥ 45 were included. Age-adjusted mortality rates (AAMRs) per 1,000,000 population were calculated. Autoregressive integrated moving average (ARIMA) models were used to project mortality trends through 2035. Results From 1999 to 2023, there were 172,511 VHD and Afib-related deaths in adults ≥ 45. AAMRs increased until 2021, followed by a slight decline to 8.86. The overall AAPC for VHD with AF was 4.01%. AAMR increase was consistent across all age groups, highest seen in 65 + individuals. Males had consistently higher AAMRs than females. AAPC for males was 4.44% and for females 3.52%. Non- Hispanic White had the highest AAMR (10.56 in 2021), followed by Hispanics (4.19). Regionally, the West had the highest AAMR (11.27), followed by Mid-West (9.94). Non-metropolitan areas had higher AAMR 8.96 compared to metropolitan areas (AAMR: 7.59). Most VHD related deaths were reported in inpatient settings (n = 396,451) and 12% involved co-diagnosed AF. Conclusion Mortality associated with VHD and AF in the U.S population aged ≥ 45 has shown a concerning increase. Predictive models indicate this trend may persist, highlighting the need for early detection, equitable healthcare access and public health interventions tailored to high-risk populations.