Abstract Body (Do not enter title and authors here):
Background:
Community-level social disadvantage is a recognized determinant of adverse cardiovascular outcomes, yet its relationship with hypertension-related hospitalizations (HTNH) among older adults remains unclear. Composite indices such as the Social Vulnerability Index (SVI) and Social Deprivation Index (SDI) have emerged as tools to quantify area-level social disadvantage. This study assessed the association of county-level SVI and SDI scores with HTNH rates among Medicare beneficiaries aged ≥65 years and compared the predictive utility of each index.

Methods:
We conducted a retrospective cross-sectional analysis using publicly available county-level data. The SDI, developed by the Robert Graham Center, is a measure of deprivation based on seven demographic characteristics. The SVI, developed by the CDC, is based on 16 social determinants of health. We linked 2019 SDI and 2018 SVI data to HTNH data from the CDC’s Interactive Atlas of Heart Disease and Stroke for adults aged 65 and older in the United States from 2019 to 2021 for each county. The linked dataset was divided into quartiles (Q1 = least disadvantaged; Q4 = most disadvantaged) based on SDI scores (0–100) and SVI scores (0–1). Mean HTNH rates per 1,000 person-years were calculated with 95% confidence intervals (CIs) and stratified by quartile, gender, and race/ethnicity. A higher rate in Q4 vs Q1, with nonoverlapping CIs, indicated a negative impact of SDI or SVI. Rate differences were calculated as excess or fewer hospitalizations per 1,000 person-years by subtracting Q1 from Q4.

Results:
The overall HTNH rate was 13.6 (95% CI: 13.4–13.8). For SDI, rates rose from 10.9 (10.6–11.2) in Q1 to 16.8 (16.4–17.2) in Q4, representing a 5.9 excess hospitalizations. Among men, rates increased from 12.6 to 18.2; among women, from 9.9 to 15.7. For SVI, rates rose from 10.6 (10.3–11.0) in Q1 to 16.5 (16.1–16.9) in Q4, again reflecting 5.9 excess hospitalizations. Disparities were also evident by race/ethnicity, with Q4 counties showing significantly higher HTNH rates than Q1 across Black, White, and Hispanic groups.

Conclusion:
Older adults with hypertension living in counties with high social disadvantage experience markedly higher HTNH rates. Both SDI and SVI effectively identify counties with elevated hospitalization risk and may support targeted public health interventions to reduce HTNH and healthcare resource utilization among Medicare beneficiaries.