Social determinants of health, life’s essential 8 metrics, and cardiovascular morbidity and mortality: a nationwide cohort study

Background: Life's Essential 8 (LE8) provides a framework to assess and improve cardiovascular health, ultimately reducing cardiovascular disease (CVD) risk. However, the role of LE8 metrics in addressing CVD disparities associated with social determinants of health (SDoH) remains unclear. Methods: This cohort study employed the National Health and Nutrition Examination Survey (2005–2018) data. Logistic regression models, Cox proportional hazard models, and multiple mediation analysis were used to assess the associations of the SDoH score with CVD morbidity (self-reported diagnosis of congestive heart failure, coronary heart disease, angina pectoris, myocardial infarction, and stroke), CVD mortality, and mortality (mortality data were derived from the NHANES Public-Use Linked Mortality File), as well as the contributions of LE8 metrics to the associations. Results: The top four reported unfavorable SDoH were low education level (21.5%), income-to-poverty ratio