Developing a Novel Index for Individual-Level Social Determinants and Cardiovascular Diseases in the Coronary Artery Risk Development in Young Adults (CARDIA) Study

Tao Gao; Yinan Zheng; Brian Joyce; Lei Liu; Lili Liu; Catarina Kiefe; Sarah Forrester; Bing Yu; Ankeet Bhatt; Penny Gordon-Larsen; Donald M Lloyd-Jones; Kai Zhang; Lifang Hou

doi:10.3390/ijerph22030422

Developing a Novel Index for Individual-Level Social Determinants and Cardiovascular Diseases in the Coronary Artery Risk Development in Young Adults (CARDIA) Study

Tao Gao, Yinan Zheng, Brian Joyce, Lei Liu, Lili Liu, Catarina Kiefe, Sarah Forrester, Bing Yu, Ankeet Bhatt, Penny Gordon-Larsen, Donald M Lloyd-Jones, Kai Zhang^*, Lifang Hou^*

^*Corresponding author for this work

Preventive Medicine

Research output: Contribution to journal › Article › peer-review

Abstract

Background: Social determinants of health (SDH) have been found to contribute to cardiovascular risk and the development of cardiovascular disease (CVD). However, few studies have examined early-life exposure to SDH and the combined effect of multiple SDH measures on CVD. There is an urgent need to develop an SDH index for use in practice and clinical settings. Methods: A total of 3189 participants from the CARDIA Study who had chest CT scans at the year-25 (Y25) visit were included in this study. Personal and parental SDH measures, including education, occupation, income, financial strain, and childhood family environment, were obtained through interviews. The participants’ coronary artery calcification (CAC) was measured using chest CT scans, and left-ventricular mass (LVM) was measured using M-mode echocardiography. The values of the individual social determinants of health (iSDH) index were determined based on individual-level measures and CAC using a supervised learning method—the Boosted Regression Tree (BRT) model. This index’s association with the LVM index (LVMI) was evaluated as an external validation using linear regression models adjusting for race, sex, BMI, smoking status, alcohol intake, and physical activity. Results: Each one-standard-deviation (SD) increase in the iSDH index was associated with an increase in LVMI ranging from 0.376 (95% CI −0.016, 0.767) at year 0 to 0.468 (95% CI 0.115, 0.821) at year 20. The association between the iSDH index and the LVMI was more pronounced as the participants aged. Also, the iSDH indices were more strongly associated with LVMI among Black participants (β = 0.969, 95% CI = 0.081, 1.858) than White participants (β = 0.202, 95% CI = −0.228, 0.633) at year 5. Conclusions: Higher iSDH indices in early adulthood were associated with increased LVMI values in midlife. The association between the iSDH index and CVD was stronger among Black adults than with White adults.

Original language	English (US)
Article number	422
Journal	International journal of environmental research and public health
Volume	22
Issue number	3
DOIs	https://doi.org/10.3390/ijerph22030422
State	Published - Mar 2025

Funding

The Coronary Artery Risk Development in Young Adults Study (CARDIA) is conducted and supported by the National Heart, Lung, and Blood Institute (NHLBI) in collaboration with the University of Alabama at Birmingham (75N92023D00002 & 75N92023D00005), Northwestern University (75N92023D00004), University of Minnesota (75N92023D00006), and Kaiser Foundation Research Institute (75N92023D00003). CARDIA is also partially supported by the Intramural Research Program of the National Institute on Aging (NIA) and an intra-agency agreement between NIA and NHLBI (AG0005). The laboratory work and analytical component were funded by the American Heart Association (17SFRN33700278, 14SFRN20790000, and 19TPA34830085) and NIA (R01AG069120, R01AG081244 and U01AG088658).

Keywords

coronary artery calcification
left ventricular mass
social determinants of health

ASJC Scopus subject areas

Pollution
Public Health, Environmental and Occupational Health
Health, Toxicology and Mutagenesis

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.3390/ijerph22030422

Cite this

Gao, T., Zheng, Y., Joyce, B., Liu, L., Liu, L., Kiefe, C., Forrester, S., Yu, B., Bhatt, A., Gordon-Larsen, P., Lloyd-Jones, D. M., Zhang, K., & Hou, L. (2025). Developing a Novel Index for Individual-Level Social Determinants and Cardiovascular Diseases in the Coronary Artery Risk Development in Young Adults (CARDIA) Study. International journal of environmental research and public health, 22(3), Article 422. https://doi.org/10.3390/ijerph22030422

@article{032cca1d889a42758841943dd15a63b0,

title = "Developing a Novel Index for Individual-Level Social Determinants and Cardiovascular Diseases in the Coronary Artery Risk Development in Young Adults (CARDIA) Study",

abstract = "Background: Social determinants of health (SDH) have been found to contribute to cardiovascular risk and the development of cardiovascular disease (CVD). However, few studies have examined early-life exposure to SDH and the combined effect of multiple SDH measures on CVD. There is an urgent need to develop an SDH index for use in practice and clinical settings. Methods: A total of 3189 participants from the CARDIA Study who had chest CT scans at the year-25 (Y25) visit were included in this study. Personal and parental SDH measures, including education, occupation, income, financial strain, and childhood family environment, were obtained through interviews. The participants{\textquoteright} coronary artery calcification (CAC) was measured using chest CT scans, and left-ventricular mass (LVM) was measured using M-mode echocardiography. The values of the individual social determinants of health (iSDH) index were determined based on individual-level measures and CAC using a supervised learning method—the Boosted Regression Tree (BRT) model. This index{\textquoteright}s association with the LVM index (LVMI) was evaluated as an external validation using linear regression models adjusting for race, sex, BMI, smoking status, alcohol intake, and physical activity. Results: Each one-standard-deviation (SD) increase in the iSDH index was associated with an increase in LVMI ranging from 0.376 (95% CI −0.016, 0.767) at year 0 to 0.468 (95% CI 0.115, 0.821) at year 20. The association between the iSDH index and the LVMI was more pronounced as the participants aged. Also, the iSDH indices were more strongly associated with LVMI among Black participants (β = 0.969, 95% CI = 0.081, 1.858) than White participants (β = 0.202, 95% CI = −0.228, 0.633) at year 5. Conclusions: Higher iSDH indices in early adulthood were associated with increased LVMI values in midlife. The association between the iSDH index and CVD was stronger among Black adults than with White adults.",

keywords = "coronary artery calcification, left ventricular mass, social determinants of health",

author = "Tao Gao and Yinan Zheng and Brian Joyce and Lei Liu and Lili Liu and Catarina Kiefe and Sarah Forrester and Bing Yu and Ankeet Bhatt and Penny Gordon-Larsen and Lloyd-Jones, {Donald M} and Kai Zhang and Lifang Hou",

note = "Publisher Copyright: {\textcopyright} 2025 by the authors.",

year = "2025",

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doi = "10.3390/ijerph22030422",

language = "English (US)",

volume = "22",

journal = "International journal of environmental research and public health",

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Gao, T , Zheng, Y , Joyce, B, Liu, L, Liu, L, Kiefe, C, Forrester, S, Yu, B, Bhatt, A, Gordon-Larsen, P, Lloyd-Jones, DM, Zhang, K & Hou, L 2025, 'Developing a Novel Index for Individual-Level Social Determinants and Cardiovascular Diseases in the Coronary Artery Risk Development in Young Adults (CARDIA) Study', International journal of environmental research and public health, vol. 22, no. 3, 422. https://doi.org/10.3390/ijerph22030422

Developing a Novel Index for Individual-Level Social Determinants and Cardiovascular Diseases in the Coronary Artery Risk Development in Young Adults (CARDIA) Study. / Gao, Tao ; Zheng, Yinan ; Joyce, Brian et al.
In: International journal of environmental research and public health, Vol. 22, No. 3, 422, 03.2025.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Developing a Novel Index for Individual-Level Social Determinants and Cardiovascular Diseases in the Coronary Artery Risk Development in Young Adults (CARDIA) Study

AU - Gao, Tao

AU - Zheng, Yinan

AU - Joyce, Brian

AU - Liu, Lei

AU - Liu, Lili

AU - Kiefe, Catarina

AU - Forrester, Sarah

AU - Yu, Bing

AU - Bhatt, Ankeet

AU - Gordon-Larsen, Penny

AU - Lloyd-Jones, Donald M

AU - Zhang, Kai

AU - Hou, Lifang

PY - 2025/3

Y1 - 2025/3

N2 - Background: Social determinants of health (SDH) have been found to contribute to cardiovascular risk and the development of cardiovascular disease (CVD). However, few studies have examined early-life exposure to SDH and the combined effect of multiple SDH measures on CVD. There is an urgent need to develop an SDH index for use in practice and clinical settings. Methods: A total of 3189 participants from the CARDIA Study who had chest CT scans at the year-25 (Y25) visit were included in this study. Personal and parental SDH measures, including education, occupation, income, financial strain, and childhood family environment, were obtained through interviews. The participants’ coronary artery calcification (CAC) was measured using chest CT scans, and left-ventricular mass (LVM) was measured using M-mode echocardiography. The values of the individual social determinants of health (iSDH) index were determined based on individual-level measures and CAC using a supervised learning method—the Boosted Regression Tree (BRT) model. This index’s association with the LVM index (LVMI) was evaluated as an external validation using linear regression models adjusting for race, sex, BMI, smoking status, alcohol intake, and physical activity. Results: Each one-standard-deviation (SD) increase in the iSDH index was associated with an increase in LVMI ranging from 0.376 (95% CI −0.016, 0.767) at year 0 to 0.468 (95% CI 0.115, 0.821) at year 20. The association between the iSDH index and the LVMI was more pronounced as the participants aged. Also, the iSDH indices were more strongly associated with LVMI among Black participants (β = 0.969, 95% CI = 0.081, 1.858) than White participants (β = 0.202, 95% CI = −0.228, 0.633) at year 5. Conclusions: Higher iSDH indices in early adulthood were associated with increased LVMI values in midlife. The association between the iSDH index and CVD was stronger among Black adults than with White adults.

AB - Background: Social determinants of health (SDH) have been found to contribute to cardiovascular risk and the development of cardiovascular disease (CVD). However, few studies have examined early-life exposure to SDH and the combined effect of multiple SDH measures on CVD. There is an urgent need to develop an SDH index for use in practice and clinical settings. Methods: A total of 3189 participants from the CARDIA Study who had chest CT scans at the year-25 (Y25) visit were included in this study. Personal and parental SDH measures, including education, occupation, income, financial strain, and childhood family environment, were obtained through interviews. The participants’ coronary artery calcification (CAC) was measured using chest CT scans, and left-ventricular mass (LVM) was measured using M-mode echocardiography. The values of the individual social determinants of health (iSDH) index were determined based on individual-level measures and CAC using a supervised learning method—the Boosted Regression Tree (BRT) model. This index’s association with the LVM index (LVMI) was evaluated as an external validation using linear regression models adjusting for race, sex, BMI, smoking status, alcohol intake, and physical activity. Results: Each one-standard-deviation (SD) increase in the iSDH index was associated with an increase in LVMI ranging from 0.376 (95% CI −0.016, 0.767) at year 0 to 0.468 (95% CI 0.115, 0.821) at year 20. The association between the iSDH index and the LVMI was more pronounced as the participants aged. Also, the iSDH indices were more strongly associated with LVMI among Black participants (β = 0.969, 95% CI = 0.081, 1.858) than White participants (β = 0.202, 95% CI = −0.228, 0.633) at year 5. Conclusions: Higher iSDH indices in early adulthood were associated with increased LVMI values in midlife. The association between the iSDH index and CVD was stronger among Black adults than with White adults.

KW - coronary artery calcification

KW - left ventricular mass

KW - social determinants of health

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U2 - 10.3390/ijerph22030422

DO - 10.3390/ijerph22030422

M3 - Article

C2 - 40238530

AN - SCOPUS:105001099887

SN - 1661-7827

VL - 22

JO - International journal of environmental research and public health

JF - International journal of environmental research and public health

IS - 3

M1 - 422

ER -

Developing a Novel Index for Individual-Level Social Determinants and Cardiovascular Diseases in the Coronary Artery Risk Development in Young Adults (CARDIA) Study

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Funding

Keywords

ASJC Scopus subject areas

UN SDGs

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