Premature CVD Mortality Higher in US Counties With Social Vulnerability

Heart ,stethoscope on cardiogram report of cardiology patient. Cardiologist and medical concept
Researchers sought to explore the link between US counties with premature CVD mortality and social vulnerabilities.

In the United States, individuals living in counties with more social vulnerabilities may be at increased risk for premature cardiovascular disease (CVD) mortality, according to findings from a cross-sectional study published in Circulation.

For the study, researchers sourced data from the Centers for Disease Control and Prevention’s (CDC) Wide-Ranging Online Data for Epidemiological Research (WONDER) and Agency for Toxic Substances and Disease Registry Social Vulnerability Index (ATSDR SVI) datasets. The researchers also used the Underlying Cause of Death files from the CDC WONDER database for insights into US adults’ cause of death between 2014 to 2018. Death certificates indicated both cause of death and demographic information.

Among the 3143 counties included in the study, the most socially vulnerable and highest ranking in CVD mortality were clustered across the Southwestern and Southeastern parts of the US.

The CVD mortality rate was 47.0 per 100,000 person-years (py) overall. The rate increased from 33.6 in the most affluent counties to 61.8 per 100,000 py in the most socially vulnerable counties. In general, mortality rates were higher in rural counties compared with urban counties (61.6 vs 44.6 per 100,000 py).

Older study participants (45-64 years) had higher CVD mortality rates than younger participants (119.6 vs 10.2 per 100,000 py); men had higher rates than women (66.2 vs 28.7 per 100,000 py); and Black individuals had higher rates than White or Hispanic individuals (87.7 vs 44.9 vs 31.2 per 100,000 py), respectively.

Among the 607,773 CVD deaths, the age-adjusted mortality rate was 28.3 per 100,000 py due to ischemic heart disease (ISD); 8.4 per 100,000 py to hypertension; 7.9 per 100,000 py to stroke; and 2.4 per 100,000 py to heart failure (HF).

Compared with the most affluent counties, the most socially vulnerable counties were at increased risk for ISD (rate ratio [RR], 1.52; 95% CI, 1.09-2.13), stroke (RR, 2.03; 95% CI, 1.12-3.70), hypertension (RR, 2.71; 1.54-4.75), and HF (RR, 3.38; 95% CI, 1.32-8.61).

This study was limited by not including data about non-Hispanic American Indian/Alaskan Native and Asian/Pacific Islander populations.

“Premature CVD mortality was higher in counties with more significant social vulnerabilities,” the study authors noted. “These findings illustrate the socioeconomic, demographic, and geographical distributions of premature CVD mortality. This information may inform future research and policy and help identify socially vulnerable populations that may benefit from evidence-based public health interventions.”

Disclosure: An author declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Khan SU, Javed Z, Lone AN, et al. Social vulnerability and premature cardiovascular mortality among US counties, 2014 to 2018. Circulation. 2021;144(16):1272-1279. doi:10.1161/CIRCULATIONAHA.121.054516