Abstract Body (Do not enter title and authors here): Social determinants of health are known to influence cardiovascular disease (CVD) risk. Communities experiencing greater social vulnerability often face structural disadvantages that contribute to higher morbidity and mortality from chronic diseases, including CVD. However, their relationship to sudden death (SD) has not been thoroughly researched yet. The present study aims to explore the relationship between CVD risk factors, CVD outcomes, and social vulnerability in victims of sudden death.

As part of the SUDDEN Project at the University of North Carolina, we screened and adjudicated 399 sudden death victims from Wake County, NC. Each victim’s address was geocoded and linked to census tract level data, including the CDC PLACES: Local Data for Better Health, and the CDC Social Vulnerability Index (SVI) datasets. We compared our sample of SD victims against census tract data in terms of CVD, other comorbidities (e.g., DM2), and healthcare utilization. We assessed the distribution of CVD risk factors (e.g., smoking), and healthcare utilization in our sample across SVI quartiles. Chi-square tests were used to evaluate differences in demographics, risk factors, and outcomes.

Overall, the 399 sudden death victims were uniformly distributed across all four SVI quartiles. However, African Americans who died suddenly were more likely to reside in high-SVI areas compared to Whites (p < 0.001). Contrary to established population-level patterns from prior studies, CVD risk factors were also uniformly distributed across SVI quartiles in our sample of SD victims. No significant differences in comorbidities were found across the SVI categories except for chronic kidney disease, which was more common in higher SVI areas, p < 0.05). However, living in an area with a higher SVI was associated with lower healthcare utilization prior to death.

While overall CVD risk factors and comorbidities were largely similar across the different levels of social vulnerability, certain disparities could be found (e.g., regarding healthcare utilization). The findings suggest that structural and access-related factors may influence healthcare engagement prior to sudden death, even when traditional CVD risk profiles appear similar. Further research is needed to clarify the relationship between social vulnerability, healthcare access, and sudden death to determine how tailored interventions can reduce these disparities.