Abstract Body (Do not enter title and authors here): Background: Social determinants of health (SDOH) impact the burden of cardiovascular disease (CVD) among Black adults, but limited information is available on how various SDOH dimensions are linked to CVD risk factors for Black ethnic subgroups and White adults. The study aimed to examine differences in the association between SDOH dimensions and CVD risk factors among Black ethnic subgroups including Black Americans (BAs), Afro-Caribbeans (ACs), African immigrants (AIs), and White adults. We hypothesized differences in the SDOH indices and CVD risk factors with stronger associations for the U.S born adults.

Methodology: Using the National Health Interview Surveys 2013-2018, we categorized 143,459 participants based on race and birthplace. A principal component analysis was used to reduce fourteen variables to four indices. Multivariable-adjusted logistic regression models were utilized to assess the associations between these SDOH indices and self-reported CVD risk factors, including hypertension, high cholesterol, and diabetes.

Results: The sample included 24, 830 Black (90% BAs, 5% ACs, 5% AIs) and 118, 979 White adults. Significant differences were observed in several social determinant factors among Black subgroups and White adults (Table 1). For AIs, there was no association between SDOH indices and CVD risk factors, except for diabetes and poor neighborhood cohesion (Table 2). Among ACs, only socioeconomic disadvantage was associated with lower odds of hypertension (OR= 0.74, 95% CI: 0.59-0.94), and all SDOH indices were associated with diabetes except for poor neighborhood cohesion. Among BAs and White adults, all SDOH indices were associated with diabetes and hypertension, except for socioeconomic disadvantage. Socioeconomic disadvantage and low healthcare access were significantly associated with high cholesterol (OR= 0.93, 95% CI: 0.89-0.98) and (OR= 1.12, 95% CI:1.04-1,19) in BAs. Among White adults, all SDOH indices were associated with high cholesterol apart from poor neighborhood cohesion (OR= 0.98, 95% CI: 0.97-1.00).
Conclusions: The relationship between CVD risk factors and SDOH indices varied across Black ethnic subgroups and White adults with more significant associations among BAs and White adults. These findings suggest that nativity may play a role in the association between SDOH and CVD risk factors.