Abstract Body: Background: Social determinants of health (SDoH) are linked with cardiovascular health, yet timely community-based atherosclerotic cardiovascular disease (ASCVD) risk assessment is often limited. We examine the associations between SDoH and ASCVD risk among older adults in Baltimore.

Methods: In this cross-sectional study in 4 Black churches in Baltimore; we assessed the cardiovascular health of older adults ages 40-79 years. We estimated ASCVD risk using the 2013 ACC/AHA pooled cohort equation (PCE) and dichotomized risk as high (PCE ≥7.5%) versus low (PCE <7.5%). An aggregate SDoH score was quantified as a cumulative number of adverse SDoH on a 7-item domain (primary care provider, health insurance, income, housing, support network, education, and employment) identified from the Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences (PRAPARE) tool; and participants were divided into groups with no adverse and at least one adverse SDoH. Logistic regression models were fitted to examine the association between SDoH factors and ASCVD risk adjusting for sex and age.

Results: Among 119 older Black adults, (mean age 59 ± 17 years, 79% female), mean systolic and diastolic BP were 130 ± 18.3 and 79 ± 10 mmHg, respectively. Overall, the mean ASCVD risk score was 13.08 (SD 10.2) with 69% having at least one adverse SDoH. From the adjusted model, compared with an income of > $20,000, ASCVD risk was 3.28 greater (95% CI, 1.15 – 9.30) among those with low income (< $20,000). Compared with the employed, ASCVD risk was 6.63 higher (95% CI, 2.61-16.67) among those who are unemployed. Having at least one adverse SDoH was associated higher risk for ASCVD 7.25 (95% CI:1.53-12.71) compared with those without no adverse SDoH (Table).

Conclusion: We found a strong association between lower income, unemployment, and having at least one adverse SDoH with increased ASCVD risk. Our findings suggest a need for targeted socio-economic policies to address these SDoH, particularly among older Black individuals, rather than individual-level strategies alone.