Social Determinants of Adherence to COVID-19 Risk Mitigation Measures Among Adults With Cardiovascular Disease

Kobina K. Hagan, Zulqarnain Javed, Miguel Cainzos-Achirica, Dirk Sostman, Farhaan S. Vahidy, Javier Valero-Elizondo, Isaac Acquah, Tamer Yahya, Bita A. Kash, Julia D. Andrieni, Prachi Dubey, Adnan A. Hyder, Khurram Nasir

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)E008118
JournalCirculation: Cardiovascular Quality and Outcomes
Issue number6
StatePublished - Jun 2021


  • cardiovascular diseases
  • physical distancing
  • self-report
  • social determinants of health
  • vaccination
  • Pandemics
  • Cross-Sectional Studies
  • Humans
  • Communicable Disease Control
  • Physical Distancing
  • SARS-CoV-2
  • United States/epidemiology
  • Social Determinants of Health
  • Adult
  • COVID-19/prevention & control
  • Cardiovascular Diseases/diagnosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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