Correlation of the Distressed Communities Index Score With Cardiovascular Risk Factors and Disease in the United States
8 affiliations
- 1University of Louisville
- 2Massachusetts General Hospital and Harvard Medical School
- 3Tulane University School of Medicine
- 4University of Pittsburgh School of Medicine
- 5Emory Center for Heart Disease Prevention, Emory University School of Medicine
- 6Columbia University Department of Medicine
- 7Lahey Hospital and Medical Center Division of Cardiology
- 8Aga Khan University
Abstract
Background Cardiovascular disease (CVD) remains the leading cause of morbidity and death worldwide. Risk scores such as the pooled cohort equations often underpredict risk in individuals with low socioeconomic status. Methods We used the Centers for Disease Control and Prevention Population Level Analysis and Community Estimates data set to obtain zip code–level prevalence of hypertension, obesity, stroke, diabetes, and coronary artery disease. The Distressed Communities Index (DCI) collates community socioeconomic status and social determinants/drivers of health metrics into a numerical score. Linear regression adjusted for region and rurality assessed associations between DCI and CVD prevalence. Results We included 26 058 US zip codes (2016–2020). The median DCI was 50.9 (interquartile range, 25.4–75.9). Each 1‐unit increase in DCI was associated with increased prevalence of obesity (β=0.10 [95% CI, 0.09–0.10]), hypertension (β=0.08 [95% CI, 0.08–0.09]), diabetes (β=0.06 [95% CI, 0.06–0.06]), coronary artery disease (β=0.03 [95% CI, 0.03–0.03]), and stroke (β=0.02 [95% CI, 0.02–0.02]; all P<0.001). Rurality and region were independently associated with CVD and risk factor prevalence, with rural and southern zip codes having the highest prevalence. Conclusions DCI, geographic region, and rurality are independently associated with greater prevalence of CVD and its risk factors in the United States. The DCI is a practical, scalable surrogate for socioeconomic status and social determinants/drivers of health that may enhance CVD risk stratification on the basis of an area's economic resilience or disadvantage. Using DCI with the Preventing Cardiovascular Events score may capture economic and social challenges it omits, warranting further study.
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BibTeX
@article{meili2026correlation,
title = {{Correlation of the Distressed Communities Index Score With Cardiovascular Risk Factors and Disease in the United States}},
author = {Zachary Meili and Shady Abohashem and Keith C. Ferdinand and Jared Magnani and Laurence Sperling and Estefania Oliveros and Sarju Ganatra and Michael W. Daniels and Salim S. Virani and Dinesh K. Kalra},
journal = {Journal of the American Heart Association},
year = {2026},
month = oct,
doi = {10.1161/jaha.125.048128},
url = {https://www.ahajournals.org/doi/10.1161/JAHA.125.048128},
note = {CC BY},
}
RIS
TY - JOUR
TI - Correlation of the Distressed Communities Index Score With Cardiovascular Risk Factors and Disease in the United States
AU - Zachary Meili
AU - Shady Abohashem
AU - Keith C. Ferdinand
AU - Jared Magnani
AU - Laurence Sperling
AU - Estefania Oliveros
AU - Sarju Ganatra
AU - Michael W. Daniels
AU - Salim S. Virani
AU - Dinesh K. Kalra
PY - 2026
DA - 2026/10/30
JO - Journal of the American Heart Association
DO - 10.1161/jaha.125.048128
UR - https://www.ahajournals.org/doi/10.1161/JAHA.125.048128
AB - Background Cardiovascular disease (CVD) remains the leading cause of morbidity and death worldwide. Risk scores such as the pooled cohort equations often underpredict risk in individuals with low socioeconomic status. Methods We used the Centers for Disease Control and Prevention Population Level Analysis and Community Estimates data set to obtain zip code–level prevalence of hypertension, obesity, stroke, diabetes, and coronary artery disease. The Distressed Communities Index (DCI) collates community socioeconomic status and social determinants/drivers of health metrics into a numerical score. Linear regression adjusted for region and rurality assessed associations between DCI and CVD prevalence. Results We included 26 058 US zip codes (2016–2020). The median DCI was 50.9 (interquartile range, 25.4–75.9). Each 1‐unit increase in DCI was associated with increased prevalence of obesity (β=0.10 [95% CI, 0.09–0.10]), hypertension (β=0.08 [95% CI, 0.08–0.09]), diabetes (β=0.06 [95% CI, 0.06–0.06]), coronary artery disease (β=0.03 [95% CI, 0.03–0.03]), and stroke (β=0.02 [95% CI, 0.02–0.02]; all P<0.001). Rurality and region were independently associated with CVD and risk factor prevalence, with rural and southern zip codes having the highest prevalence. Conclusions DCI, geographic region, and rurality are independently associated with greater prevalence of CVD and its risk factors in the United States. The DCI is a practical, scalable surrogate for socioeconomic status and social determinants/drivers of health that may enhance CVD risk stratification on the basis of an area's economic resilience or disadvantage. Using DCI with the Preventing Cardiovascular Events score may capture economic and social challenges it omits, warranting further study.
SN - 2047-9980
ER -