Maureen McGlinchey Ford, Cyle D Rogotzke, Sherrie L Bencik, Joseph R Billian, Jeffrey L Young, Cambrie D Bencik, Joshua D Mastenbrook
Teaching Cardiopulmonary Resuscitation to Later Elementary School Students
Annals of emergency medicine
benefit adding social determinants health sdoh estimating atherosclerotic cardiovascular disease ascvd risk unclear examine association sdoh individual area levels ascvd risks assess adding individual arealevel sdoh pooled cohort equations pces predicting risk cvd events prevent equations improves accuracy risk estimates cohort study included participants data 4 large us cohort studies eligible participants aged 40 79 years without history ascvd baseline data collected 1995 2007 median iqr followup 130 93150 years data analyzed september 2023 february 2024 individual arealevel education income employment status ascvd defined composite outcome nonfatal myocardial infarction death coronary heart disease fatal nonfatal stroke total 26 316 participants included mean sd age 610 91 years 15 494 women 589 11 365 black 432 703 chinese american 27 1278 hispanic 49 12 970 white 493 11 764 individuals 447 least 1 adverse individuallevel sdoh 10 908 415 least 1 adverse arealevel sdoh total 2673 ascvd events occurred followup sdoh associated increased risk ascvd individual area levels including low education individual hazard ratio hr 139 95 ci 125155 area hr 131 95 ci 120142 low income individual 135 95 ci 125147 area hr 128 95 ci 117140 unemployment individual hr 161 95 ci 124210 area hr 125 95 ci 114137 adding arealevel sdoh alone pces change model discrimination modestly improved calibration furthermore adding individual arealevel sdoh pces led modest improvement discrimination calibration nonhispanic black individuals change c index 00051 95 ci 00011 00126 change scaled integrated brier score ibs 0396 95 ci 0221 0802 improvement calibration white individuals change scaled ibs 0274 95 ci 0095 0665 adding individuallevel sdoh prevent plus arealevel social deprivation index sdi equations improve discrimination modestly improved calibration white participants change scaled ibs 0182 95 ci 0040 0496 black participants 0187 95 ci 0039 0501 women 0289 95 ci 0115 0574 cohort study individual arealevel sdoh associated ascvd risk adding individual arealevel sdoh pces modestly improved discrimination calibration estimating ascvd risk black individuals adding individuallevel sdoh prevent plus sdi also modestly improved calibration findings suggest individual arealevel sdoh may considered future development ascvd risk assessment tools particularly among black individuals