Pregnancy is an educable and actionable life stage to address social determinants of health (SDOH) and lifelong cardiovascular disease (CVD) prevention. However, the link between a risk score that combines multiple neighborhood-level social determinants in pregnancy and the risk of long-term CVD remains to be evaluated. To examine whether neighborhood-level socioeconomic disadvantage measured by the Area Deprivation Index (ADI) in early pregnancy is associated with a higher 30-year predicted risk of CVD postpartum, as measured by the Framingham Risk Score. An analysis of data from the prospective Nulliparous Pregnancy Outcomes Study-Monitoring Mothers-to-Be Heart Health Study longitudinal cohort. Participant home addresses during early pregnancy were geocoded at the Census-block level. The exposure was neighborhood-level socioeconomic disadvantage using the 2015 ADI by tertile (least deprived [T1], reference; most deprived [T3]) measured in the first trimester. Outcomes were the predicted 30-year risks of atherosclerotic cardiovascular disease (ASCVD, composite of fatal and nonfatal coronary heart disease and stroke) and total CVD (composite of ASCVD plus coronary insufficiency, angina pectoris, transient ischemic attack, intermittent claudication, and heart failure) using the Framingham Risk Score measured 2 to 7 years after delivery. These outcomes were assessed as continuous measures of absolute estimated risk in increments of 1%, and, secondarily, as categorical measures with high-risk defined as an estimated probability of CVD ≥10%. Multivariable linear regression and modified Poisson regression models adjusted for baseline age and individual-level social determinants, including health insurance, educational attainment, and household poverty. Among 4309 nulliparous individuals at baseline, the median age was 27 years (interquartile range [IQR]: 23–31) and the median ADI was 43 (IQR: 22–74). At 2 to 7 years postpartum (median: 3.1 years, IQR: 2.5, 3.7), the median 30-year risk of ASCVD was 2.3% (IQR: 1.5, 3.5) and of total CVD was 5.5% (IQR: 3.7, 7.9); 2.2% and 14.3% of individuals had predicted 30-year risk ≥10%, respectively. Individuals living in the highest ADI tertile had a higher predicted risk of 30-year ASCVD % (adjusted ß: 0.41; 95% confidence interval [CI]: 0.19, 0.63) compared with those in the lowest tertile; and those living in the top 2 ADI tertiles had higher absolute risks of 30-year total CVD % (T2: adj. ß: 0.37; 95% CI: 0.03, 0.72; T3: adj. ß: 0.74; 95% CI: 0.36, 1.13). Similarly, individuals living in neighborhoods in the highest ADI tertile were more likely to have a high 30-year predicted risk of ASCVD (adjusted risk ratio [aRR]: 2.21; 95% CI: 1.21, 4.02) and total CVD ≥10% (aRR: 1.35; 95% CI: 1.08, 1.69). Neighborhood-level socioeconomic disadvantage in early pregnancy was associated with a higher estimated long-term risk of CVD postpartum. Incorporating aggregated SDOH into existing clinical workflows and future research in pregnancy could reduce disparities in maternal cardiovascular health across the lifespan, and requires further study.

中文翻译：

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妊娠期的社会经济劣势和产后心血管疾病的风险


怀孕是一个可教育和可行动的生命阶段，可解决健康的社会决定因素 (SDOH) 和终身心血管疾病 (CVD) 预防问题。然而，结合妊娠期多个社区级社会决定因素的风险评分与长期心血管疾病风险之间的联系仍有待评估。旨在检查妊娠早期通过面积剥夺指数 (ADI) 衡量的社区级社会经济劣势是否与通过弗雷明汉风险评分衡量的 30 年预测产后 CVD 风险较高相关。对前瞻性未产妊娠结果研究——监测准妈妈心脏健康研究纵向队列的数据进行分析。怀孕早期参与者的家庭地址在人口普查区块级别进行了地理编码。使用 2015 年 ADI（按三分位数划分的最贫困 [T1]，参考；最贫困 [T3]）测量的前三个月的邻里水平社会经济劣势。结果是动脉粥样硬化性心血管疾病（ASCVD，致命性和非致命性冠心病和中风的复合疾病）和总 CVD（ASCVD 加上冠状动脉供血不足、心绞痛、短暂性脑缺血发作、间歇性跛行和心力衰竭的复合疾病）的预测 30 年风险）使用分娩后 2 至 7 年测量的弗雷明汉风险评分。这些结果被评估为以 1% 为增量的绝对估计风险的连续测量，其次，作为高风险的分类测量，定义为 CVD 估计概率≥10%。根据基线年龄和个人层面的社会决定因素（包括健康保险、教育程度和家庭贫困）调整多变量线性回归和修正泊松回归模型。 在基线时的 4309 名未生育个体中，中位年龄为 27 岁（四分位距 [IQR]：23-31），中位 ADI 为 43（IQR：22-74）。产后 2 至 7 年（中位：3.1 年，IQR：2.5, 3.7），30 年 ASCVD 风险中位为 2.3%（IQR：1.5, 3.5），总 CVD 风险为 5.5%（IQR：3.7, 7.9） ）；分别有 2.2% 和 14.3% 的人预测 30 年风险≥10%。与生活在最低三分位数的人相比，生活在最高 ADI 三分位数的个体的 30 年 ASCVD % 预测风险较高（调整后 ß：0.41；95% 置信区间 [CI]：0.19，0.63）；生活在 ADI 前 2 个三分位数的人的 30 年总 CVD % 绝对风险较高（T2：调整后 ß：0.37；95% CI：0.03, 0.72；T3：调整后 ß：0.74；95% CI：0.36 ，1.13）。同样，居住在 ADI 最高三分位社区的个人更有可能具有较高的 30 年预测 ASCVD 风险（调整后风险比 [aRR]：2.21；95% CI：1.21，4.02）且总 CVD ≥10%（ aRR：1.35；95% CI：1.08，1.69）。怀孕早期的社区社会经济劣势与产后较高的 CVD 长期风险估计相关。将聚合的 SDOH 纳入现有的临床工作流程和未来的妊娠研究可以减少孕产妇整个生命周期心血管健康的差异，需要进一步研究。