Social Determinants, Cardiovascular Disease, and Health Care Cost: A Nationwide Study in the United States Using Machine Learning

Feinuo Sun, Jie Yao, Shichao Du, Feng Qian, Allison A. Appleton, Cui Tao, Hua Xu, Lei Liu, Qi Dai, Brian T. Joyce, Drew R. Nannini, Lifang Hou*, Kai Zhang*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


BACKGROUND: Existing studies on cardiovascular diseases (CVDs) often focus on individual-level behavioral risk factors, but research examining social determinants is limited. This study applies a novel machine learning approach to identify the key predictors of county-level care costs and prevalence of CVDs (including atrial fibrillation, acute myocardial infarction, congestive heart failure, and ischemic heart disease). METHODS AND RESULTS: We applied the extreme gradient boosting machine learning approach to a total of 3137 counties. Data are from the Interactive Atlas of Heart Disease and Stroke and a variety of national data sets. We found that although demographic composition (eg, percentages of Black people and older adults) and risk factors (eg, smoking and physical inactivity) are among the most important predictors for inpatient care costs and CVD prevalence, contextual factors such as social vulnerability and racial and ethnic segregation are particularly important for the total and outpatient care costs. Poverty and income inequality are the major contributors to the total care costs for counties that are in nonmetro areas or have high segregation or social vulnerability levels. Racial and ethnic segregation is particularly important in shaping the total care costs for counties with low poverty rates or social vulnerability level. Demographic composition, education, and social vulnerability are consistently important across different scenarios. CONCLUSIONS: The findings highlight the differences in predictors for different types of CVD cost outcomes and the importance of social determinants. Interventions directed toward areas that have been economically and socially marginalized may aid in reducing the impact of CVDs.

Original languageEnglish (US)
Article numbere027919
JournalJournal of the American Heart Association
Issue number5
StatePublished - Mar 7 2023


  • cardiovascular disease
  • health care costs
  • machine learning
  • racial and ethnic segregation
  • social determinants of health

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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