Background:Social determinants of health (SDOH) may limit the practice of coronavirus disease 2019 (COVID-19) risk mitigation guidelines with health implications for individuals with underlying cardiovascular disease (CVD). Population-based evidence of the association between SDOH and practicing such mitigation strategies in adults with CVD is lacking. We used the National Opinion Research Center’s COVID-19 Household Impact Survey conducted between April and June 2020 to evaluate sociodemographic disparities in adherence to COVID-19 risk mitigation measures in a sample of respondents with underlying CVD representing 18 geographic areas of the United States.Methods:CVD status was ascertained by self-reported history of receiving heart disease, heart attack, or stroke diagnosis. We built de novo, a cumulative index of SDOH burden using education, insurance, economic stability, 30-day food security, urbanicity, neighborhood quality, and integration. We described the practice of measures under the broad strategies of personal protection (mask, hand hygiene, and physical distancing), social distancing (avoiding crowds, restaurants, social activities, and high-risk contact), and work flexibility (work from home, canceling/postponing work). We reported prevalence ratios and 95% CIs for the association between SDOH burden (quartiles of cumulative indices) and practicing these measures adjusting for age, sex, race/ethnicity, comorbidity, and interview wave.Results:Two thousand thirty-six of 25 269 (7.0%) adults, representing 8.69 million in 18 geographic areas of the United States, reported underlying CVD. Compared with the least SDOH burden, fewer individuals with the greatest SDOH burden practiced all personal protection (75.6% versus 89.0%) and social distancing measures (41.9% versus 58.9%) and had any flexible work schedule (26.2% versus 41.4%). These associations remained statistically significant after full adjustment: personal protection (prevalence ratio, 0.83 [95% CI, 0.73–0.96]; P=0.009), social distancing (prevalence ratio, 0.69 [95% CI, 0.51–0.94]; P=0.018), and work flexibility (prevalence ratio, 0.53 [95% CI, 0.36–0.79]; P=0.002).Conclusions:SDOH burden is associated with lower COVID-19 risk mitigation practices in the CVD population. Identifying and prioritizing individuals whose medical vulnerability is compounded by social adversity may optimize emerging preventive efforts, including vaccination guidelines.

中文翻译：

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心血管疾病成人遵守 COVID-19 风险缓解措施的社会决定因素

背景：健康的社会决定因素 (SDOH) 可能会限制 2019 年冠状病毒病 (COVID-19) 风险缓解指南的实践，对潜在心血管疾病 (CVD) 患者的健康产生影响。缺乏基于人群的证据表明 SDOH 与在患有 CVD 的成人中实施此类缓解策略之间存在关联。我们使用国家意见研究中心在 2020 年 4 月至 2020 年 6 月期间进行的 COVID-19 家庭影响调查，评估了代表美国 18 个地理区域的潜在 CVD 受访者样本在遵守 COVID-19 风险缓解措施方面的社会人口差异。 ：CVD 状态通过自我报告的心脏病、心脏病发作或中风诊断史确定。我们建立了 de novo，一个使用教育的 SDOH 负担累积指数，保险、经济稳定、30 天粮食安全、城市化、邻里质量和融合。我们描述了在个人保护（口罩、手部卫生和身体距离）、社交距离（避免人群、餐馆、社交活动和高风险接触）和工作灵活性（在家工作、取消/推迟工作）。我们报告了 SDOH 负担（累积指数的四分位数）与针对年龄、性别、种族/民族、合并症和访谈波调整这些措施之间关联的患病率和 95% CI。 结果：25269 中的 2036 个(7.0%) 成年人，代表美国 18 个地理区域的 869 万，报告了潜在的 CVD。与最小的 SDOH 负担相比，较少的 SDOH 负担最重的人采取了所有个人保护（75.6% 对 89.0%）和社会疏远措施（41.9% 对 58.9%）并具有灵活的工作时间表（26.2% 对 41.4%）。这些关联在完全调整后仍然具有统计学意义：个人保护（患病率，0.83 [95% CI，0.73–0.96]；P = 0.009）、社交距离（患病率，0.69 [95% CI，0.51–0.94]；P = 0.018）和工作灵活性（患病率，0.53 [95% CI，0.36–0.79]；P = 0.002）。结论：SDOH 负担与 CVD 人群中较低的 COVID-19 风险缓解做法相关。识别和优先考虑那些医疗脆弱性因社会逆境而复杂化的个人，可以优化新兴的预防工作，包括疫苗接种指南。