Development and validation of a county-level social determinants of health risk assessment tool for cardiovascular disease

Abstract

PURPOSE Social determinants of health (SDoH) have been linked to a variety of health conditions, but there are no multivariate measures of these determinants to estimate the risk of morbidity or mortality in a community. We developed a score derived from multivariate measures of SDoH that predicts county-level cardiovascular disease (CVD) mortality. METHODS Using county-level data from 3,026 US counties, we developed a score considering variables of neighborhood socioeconomic status, food/lifestyle environment, and health care resource availability and accessibility to predict the 3-year average (2015-2017) age-adjusted county-level mortality rate for all CVD. We used one 50% random sample to develop the score and the other to validate the score. A Poisson regression model was developed to estimate parameters of variables while accounting for intrastate correlation. RESULTS The index score was based on 7 SDoH factors: percentage of the population of minority (nonwhite) race, poverty rate, percentage of the population without a high school diploma, grocery store ratio, fast-food restaurant ratio, after-tax soda price, and primary care physician supply. The area under the curve for the development and validation groups was similar, 0.851 (95% CI, 0.829-0.872) and 0.840 (95% CI, 0.817-0.863), respectively, indicating excellent discriminative ability. The index had better predictive performance for CVD burden than other area-level indexes: poverty only (area under the curve=0.808, P