Abstract Body (Do not enter title and authors here): Background
Peripheral artery disease (PAD) continues to pose a significant public health burden in the United States (U.S.), contributing to increased morbidity, functional decline, and mortality. While social determinants of health have been shown to influence overall cardiovascular outcomes, their specific effect on PAD-related mortality remains underexplored. We therefore analyzed the association between county-level Social Vulnerability Index (SVI), Social Deprivation Index (SDI), and PAD-related mortality across the U.S.

Methods
County-level PAD-related mortality data for adults aged >25 years were obtained from the CDC WONDER database (1999–2020) and linked to the corresponding 2022 SVI and 2019 SDI data. Counties with PAD related deaths fewer than 10 were excluded from the CDC database to protect confidentiality and ensure statistical reliability. SDI data which measures area-level socioeconomic disadvantage was derived from the American Community Survey and SVI data were obtained from the CDC. PAD-related mortalities were stratified by SVI and SDI quartiles, with the 1st quartile (Q1) representing the least vulnerable and the 4th quartile (Q4) the most vulnerable. PAD age adjusted mortality rates(AAMR) per 100,000 deaths with 95% confidence intervals (CI) were calculated for each quartile and stratified by sex and race. A higher PAD related mortality in Q4 than Q1 with non-overlapping CIs was considered evidence of a negative impact.

Results
A total of 396 counties from 43 states were included. For SDI, there was no linear association with PAD-related mortality. The AAMR in Q1 was 2.12 (95% CI: 1.17–3.08) compared to 1.95 (1.47–2.42) in Q4, with overlapping CIs indicating no significant difference. This trend was consistent across sexes and racial groups (Table 1). A similar pattern was observed for SVI, with a rate of 2.12 (1.45–2.79) in Q1 and 1.58 (1.17–1.99) in Q4, again with overlapping CIs. Subgroup analyses by SDI also showed overlapping CIs between Q1 and Q4 (Table 2).

Conclusions
Higher SDI and SVI scores were not associated with increased PAD-related mortality. Further research exploring alternative social indices may improve risk prediction and help identify truly vulnerable populations.