Abstract Body: Introduction
Social determinants of health (SDOH) have been shown to impact access to care and health outcomes. However, the relationship between blood pressure (BP) control and exposure to different SDOH resources and hazards is not well understood.

Hypothesis
We hypothesized that achievement of BP goals among people with diabetes will be negatively associated with greater distance to Supplemental Nutrition Assistance Program (SNAP) retailers, hospitals, and pharmacies; and positively associated with greater distance to gun violence incidents.

Methods
We assessed attainment of BP ≤140/90 mmHg (primary outcome) and ≤130/80 mmHg (secondary outcome), averaged per year, among adults with diabetes in the University of Maryland Medical System (UMMS) in 2023 and 2024. Encounters with missing BP data, systolic BP <60 mmHg or >240 mmHg, and diastolic BP <30 mmHg or >160 mmHg were excluded. The four SDOH paraments tested were distance to a SNAP retailer, hospital, gun violence incident, and pharmacy. These factors were selected to reflect different domains of SDOH that may impact hypertension management. Multivariate analyses controlled for urbanicity, age, and type of diabetes.

Results
We included 8,978 adults with diabetes. Achieving BP goal of ≤140/90 mmHg was associated with greater distance from a gun violence incident (OR 93.00, CI: 2.75-3135.84) and greater distance to a hospital (OR 9.15, CI: 2.18-38.41). There was no association between attaining BP ≤140/90 and distance to a SNAP retailer or pharmacy. Greater distance to hospital (OR 2.32, CI: 1.07-5.01) was also associated with achievement of BP ≤130/80 mmHg.

Conclusion
BP control was associated with some, but not all, SDOH indicators tested among adults with diabetes within a large, state-wide health system. While BP target attainment was more likely with further distance from gun violence incidents (a major stressor), there was no association with proximity to SNAP (food) retailers or pharmacies, and the association with distance to the hospital was inverse to our hypothesis. Further analyses are needed to quantify and explore the role of geographical SDOH parameters on BP control.