Abstract Body: Poor cardiovascular-kidney-metabolic (CKM) health is associated with an increased risk for cardiovascular disease events and cardiovascular mortality in adults. There is a disproportionate burden of CKM syndrome among adults with social risk factors, and the presence of social risk factors can contribute to health and healthcare disparities in patients with CKM syndrome. Nothing is known about the association of social risk factors with CKM syndrome in youth with hypertension disorders.

We conducted a cross-sectional analysis of baseline data from the Study of the Epidemiology of Pediatric Hypertension (SUPERHERO), a retrospective Registry of electronic health record data obtained using standardized and validated biomedical informatics scripts. Inclusion criteria were youth <19 years old who received care from subspecialists for hypertension disorders from 1/1/2026–12/31/2023 defined by ICD-10 codes. Exclusion criteria were kidney failure on dialysis, kidney transplantation, or pregnancy by ICD-10 codes. The outcome was CKM syndrome defined by ICD-10 codes and included no risk, stage 1 and stage 2 CKM syndrome; for this analysis we excluded those who were unclassified (n=630, 7%). Exposure was presence of at least one social risk factor defined by ICD-10 codes and included food access, transportation, housing, income, education, employment, family, and crime. We used directed acyclic graph-informed bivariate generalized linear models; no biasing paths were present so no additional covariates were included.

Of 8,726 participants, the mean age was 12.8 years (SD 4.5) and 62% were male. CKM syndrome stage 1 prevalence was 20% and CKM stage 2 was 65%. Seventy-four (0.8%) youth had at least one social risk factor. Presence of social risk factors was not associated with CKM syndrome (OR 0.9, 95% CL 0.6 to 1.5).

Among youth referred for hypertension disorders, we found that those with social risk factors were not more likely to have CKM syndrome. Given the low prevalence of social risk factors by ICD-10 codes only in this early SUPERHERO phase, there is a critical need for a transdisciplinary approach to more comprehensively screen for and identify social risk factors. Further investigation into this important topic may inform risk stratification based on presence of social risk factors and targeted interventions to improve CKM health. Future SUPERHERO analysis will investigate the impact of interventions addressing social risk factors on CKM health outcomes.