AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Social Determinants of Health and Cardio-Kidney Metabolic Syndrome Progression: The Dallas Heart Study
By Zierath R, Shelbaya K, Yang Y et al.
Introduction: Adverse social determinants of health (SDOH) associate with higher cardiovascular-kidney-metabolic (CKM) stage in cross-sectional analyses, but limited data exist regarding associations of cumulative SDOH burden and or individual SDOH measures with CKM progression over time. Methods: Among 1,446 participants of the Dallas Heart Study (DHS) with data necessary for CKM stage classification and SDOH at the first (2000-2002) and second (2007-2009) study visits, we assessed associations of a cumulative SDOH score (sum of adverse metrics using the following dichotomized measures: low income, low educational attainment, food insecurity, poor food shopping access, high neighborhood disadvantage, high neighborhood violence, high discrimination, poor healthcare access, and high air pollution) with (a) CKM stage using ordinal logistic regression, and (b) CKM stage progression from Visit 1 to 2 using logistic regression. Cross-sectional models were adjusted for age and sex, while progression models were adjusted for age, sex, and CKM stage at baseline. Results: Among 1,446 DHS participants, the mean age was 44±10 years at Visit 1 and 51±10 at Visit 2, 58% were female, and 51% self-reported Black race. CKM stage 2 was most prevalent at both Visits, while the prevalence of advanced CKM stages 3 and 4 increased from 18% at Visit 1 to 35% at Visit 2 ( Figure ). The median (IQR) cumulative SDOH score at Visit 1 was 3 (2, 4) (possible range 0-9). Higher cumulative SDOH score was associated with more advanced CKM stage cross-sectionally at Visit 1. Over a median of 7 years between Visits 1 and 2, 38% of participants progressed in CKM Stage. Each 1-point increase in SDOH score was also associated with 17% greater odds of CKM progression from Visit 1 to Visit 2, an association that was most prominent among participants with Stage 3 CKM at baseline. Low income, poor food shopping access, greater neighborhood disadvantage, and greater neighborhood violence were each individually associated with both higher CKM stage cross-sectionally and with greater odds of CKM progression, with the strongest associations observed among participants with Stage 3 CKM at baseline. Conclusions: Adverse SDOH are associated with greater CKM Stage progression over 7 years in mid-life, particularly among CKM Stage 3 individuals. Among SDOH, unfavorable neighborhood conditions and financial disadvantage were most strongly associated with stage progression, and may be particularly important to prioritize for CKM prevention.