title: Association between cumulative social risk and ideal cardiovascular health in US adults: NHANES 1999-2006.
abstract: BACKGROUND
  The American Heart Association developed the Life's Simple 7 metric for defining cardiovascular health. Little is known about the association of co-occurring social risk factors on ideal cardiovascular health.
  
  
  METHODS
  Using data on 11,467 adults aged ≥25 years from the National Health and Nutrition Examination Survey 1999-2006, we examined the association between cumulative social risk and ideal cardiovascular health in US adults. A cumulative risk score (range 0 to 3 or 4) was created by summing four social risk factors (low family income, low education level, minority race, and single-living status). Ideal levels for each component in Life's Simple 7 (blood pressure, cholesterol, glucose, BMI, smoking, physical activity, and diet) were used to create an ideal Life's Simple 7 score [0-1 (low), 2, 3, 4, and 5-7 (high)].
  
  
  RESULTS
  Adults with low income (odds ratio [OR]=0.30 [95% CI 0.23-0.39]), low education [0.22 (0.16-0.28)], who are non-white (0.44 [0.36-0.54]) and single-living [0.79 (0.67-0.95)] were less likely to have 5-7 versus 0 ideal Life's Simple 7 scores after adjustment for age and sex. Adults were less likely to attain 5-7 versus 0 ideal Life's Simple 7 scores as exposure to the number of social risk factors increased [OR (95% CI) of 0.58 (0.49-0.68); 0.27 (0.21-0.35); and 0.19 (0.14-0.27) for cumulative social risk scores of 1, 2, and 3 or 4, respectively, each versus 0].
  
  
  CONCLUSIONS
  US adults with an increasing number of socially risk factors, were progressively less likely to attain ideal levels of cardiovascular health factors.
authors.affiliation: Department of Health Policy and Management, Mailman School of Public Health, Columbia University, NY 10032, USA. Electronic address: r.caleyachetty@icloud.com.
authors.forename: Rishi
authors.initials: R
authors.lastname: Caleyachetty
authors.affiliation: Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Department of Medicine, MedStar Health System, Baltimore, MD, USA.
authors.forename: Justin B
authors.initials: JB
authors.lastname: Echouffo-Tcheugui
authors.affiliation: Department of Health Policy and Management, Mailman School of Public Health, Columbia University, NY 10032, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Muennig
authors.affiliation: Department of Health Policy and Management, Mailman School of Public Health, Columbia University, NY 10032, USA.
authors.forename: Wenyi
authors.initials: W
authors.lastname: Zhu
authors.affiliation: Department of Epidemiology, University of Alabama at Birmingham, 1665 University Boulevard, Suite 230 J, Birmingham, AL 35294, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Muntner
authors.affiliation: Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical Center, New York, NY 10032, USA.
authors.forename: Daichi
authors.initials: D
authors.lastname: Shimbo
mesh_terms: D000328:Adult; D000572:American Heart Association; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys / Q000639:trends*; D012307:Risk Factors; D012923:Social Class; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology
keywords: Cardiovascular health; Cumulative social risk; Life's Simple 7