Social Determinants of Adherence to COVID-19 Risk Mitigation Measures Among Adults with Cardiovascular Disease

Background: Social determinants of health (SDOH) may limit the practice of COVID-19 risk mitigation guidelines with health implications for individuals with underlying cardiovascular disease (CVD). Population-based evidence of the association between SDOH and practicing such mitigation strategies in adults with CVD is lacking. We used the National Opinion Research Center’s COVID-19 Household Impact Survey conducted between April and June 2020 to evaluate sociodemographic disparities in adherence to COVID-19 risk mitigation measures in a sample of respondents with underlying CVD representing 18 geographic areas of the United States (US).

Methods: CVD status was ascertained by self-reported history of receiving heart disease, heart attack, or stroke diagnosis. We built de novo, a cumulative index of SDOH burden using education, insurance, economic stability, 30-day food security, urbanicity, neighborhood quality, and integration. We described the practice of measures under the broad strategies of personal protection (mask, hand hygiene, physical distancing), social distancing (avoiding crowds, restaurants, social activities, and high-risk contact), and work flexibility (work-from-home, canceling/postponing work). We reported prevalence ratios (PR) and 95% confidence intervals (CIs) for the association between SDOH burden (quartiles of cumulative indices) and practicing these measures adjusting for age, sex, race/ethnicity, comorbidity, and interview wave.

Results: 2036/25269 (7.0%) adults, representing 8.69 million in 18 geographic areas of the US, reported underlying CVD. Compared to the least SDOH burden, fewer individuals with the greatest SDOH burden practiced all personal protection (75.6% vs 89.0%) and social distancing measures (41.9% vs 58.9%) and had any flexible work schedule (26.2% vs 41.4%). These associations remained statistically significant after full adjustment: personal protection, (PR = 0.83; 95% CI [0.73-0.96]; P = 0.009); social distancing (PR = 0.69; 95% CI [0.51-0.94]; P = 0.018); and work flexibility (PR = 0.53; 95% CI [0.36-0.79]; P = 0.002).

Conclusions: SDOH burden is associated with lower COVID-19 risk mitigation practices in the CVD population. Identifying and prioritizing individuals whose medical vulnerability is compounded by social adversity may optimize emerging preventive efforts, including vaccination guidelines.