Cardiovascular disease (CVD) mortality rates have decreased more than 70% since the 1960s due to medical advancements. However, some groups have benefitted from these gains more than others, contributing to an array of heart health disparities.

The expansive impact of SDoH

So, how can we improve these disparities and achieve equitable cardiovascular care? Houston Methodist researchers are looking beyond clinic walls to find out.

“Our aspirations and pursuit of health does not start and end in the clinic. Providers must account for the conditions in which people live, learn, work and play, now broadly known as the social determinants of health (SDoH).”

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Khurram Nasir, MD, MPH
Professor of Cardiology

As it turns out, these social conditions can have a profound impact on health outcomes and quality of life, independent of clinical risk factors. In fact, research suggests that SDoH accounts for approximately 80% of health outcomes in the US.

These staggering statistics have motivated Khurram Nasir, MD, MPH, Professor of Cardiology, to design some of the nation’s most comprehensive and innovative cardiovascular research studies that illuminate the expansive health impacts of SDoH. The results of these studies will be used to accomplish two goals: integrate SDoH data into clinical decision support systems and support the development of a health care system that addresses patients’ clinical and often concurrent social needs — a phenomenon Nasir and his team refer to as, “cumulative social risk.”

However, to effectively reduce patients’ cumulative social risk, researchers must better understand cumulative social risk as an upstream predictor of downstream health outcomes.

Filling this knowledge gap requires overcoming common study limitations, such as a limited number of SDoH variables that do not comprehensively capture the health impacts of concurrent social needs, and a lack of incident risk longitudinal data for CVD and other leading health outcomes.

Breaking down the data

Enter Zulqarnain Javed, PhD, MBBS, MPH, Assistant Professor of Population Health in the Department of Cardiology at Houston Methodist.

Working closely with Nasir, Javed pioneered the development of novel SDoH frameworks and risk indices to address these common study limitations.

One such development includes the polysocial risk score, a tool used to measure the potential health impacts of more than 40 SDoH variables — a massive step forward in better understanding how cumulative social risk serves as a predictor for cardiovascular health outcomes.

For example, in Nasir and Javed’s latest study in the American Heart Journal, the pair used the polysocial risk scoring approach to investigate the impact of cumulative social risk on all-cause and atherosclerotic cardiovascular disease (ASCVD) mortality risk.

The nationally representative study revealed that the more social disadvantages patients face, the higher their all-cause and ASCVD mortality risk.

This pattern was observed consistently for both adults with and without existing ASCVD, as well as across gender and racial/ethnic subgroups. The pattern also remained evident even after adjusting for traditional risk factors of heart disease, such as obesity, diabetes, smoking and dyslipidemia.

These significant study results add to the growing body of evidence that addressing social disadvantages is key in mitigating health and mortality risk disparities.

“If we have any aspirations of achieving health equity without focusing on SDoH, we are flying blindly,” Javed said.

Future efforts

This novel study is just another step forward for Nasir and Javed, who have become quite the “dynamic duo.”

The pair have published more than 50 cardiovascular SDoH studies that have garnered national attention for their inventive approaches to research challenges. They are also actively engaged in innovative translational projects to address SDoH at the community level.

One such project involves working with top health care systems, including Yale School of Medicine, Massachusetts General Hospital and Sentara Healthcare on a $19 million study funded by the Patient-Centered Outcomes Research Institute (PCORI).

This multi-center, national study seeks to address social needs and optimize hypertension management in underserved patient populations in New Haven, CT; Hampton Roads, VA; Boston, MA; and Houston, TX via a novel telehealth, health advocate and community health worker model.

Nasir and Javed’s research has also been incredibly helpful in developing Houston Methodist’s own SDoH screening program, which screens patients for social needs and informs efforts to connect them with community-based agencies that can help address those needs. The program is in its pilot stage but shows promise for improving health outcomes in the next few years.

Through these collaborative projects, Nasir and Javed hope to inspire a more equitable U.S. health care system.

"If we have any aspirations of achieving health equity without focusing on SDoH, we are flying blindly," said Zulqarnain Javed PhD, MBBS, MPH, Assistant Professor of Population Health, Cardiology.

While the humble pair are proud of these accomplishments, Nasir and Javed have no plans to slow down. They’re already in the process of using artificial intelligence to enhance the polysocial risk score’s capabilities.

“We are delighted to be part of Houston Methodist and take what we have created and implement it into the real world,” Nasir said. “We are very happy that there is a strong belief and investment in our research.”

In a final note, Nasir added that if the long-term goal is to achieve health equity, policymakers, community members, health care providers, researchers and other key stakeholders must unite to create systemic change.

“It's sobering to realize that the current health care system is not set up to provide holistic care, which can reduce the development of chronic disease,” Nasir noted. “We must adopt a new perspective on health care. It’s our social responsibility.”

See Nasir and Javed’s other research publications.