Social determinants of health clusters and risk of cardiovascular disease among community-dwelling older men and women: A clustering and causal machine learning approach
Achamyeleh Birhanu Teshale , Htet Lin Htun , Alice J. Owen , Mor Vered , Christopher M. Reid , Andrew Tonkin , Rosanne Freak-Poli
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引用次数: 0
Abstract
Background
Social determinants of health (SDoH) significantly impact cardiovascular disease (CVD) risk. This study aims to identify SDoH clusters and explore their cumulative effects on CVD risk.
Methods
Data from the ASPirin in Reducing Events in the Elderly (ASPREE) trial, ASPREE eXTension study, and ASPREE Longitudinal Study of Older Persons (ALSOP) were used. The study participants were community-dwelling healthy individuals (5884 men and 7012 women) aged 70+ years. These participants were followed for 12 years (median: 8.4 years). The K-prototype algorithm to identify clusters of SDoH and the Cox model to evaluate the association between the SDoH clusters and CVD events were used. Causal Survival Forest was employed to explore the heterogenous treatment effect (HTE) of the SDoH clusters on CVD events.
Results
Two SDoH clusters, disadvantageous and advantageous, were identified. The advantageous group were more economically stable, socially active, and had positive neighbourhood factors. Being membership in the advantageous group was statistically significantly associated with a 31 % reduced risk of CVD events among women. By taking the disadvantageous SDoH group as the control group and the advantageous group as the treated group, there was indication of HTE on CVD among women; women who were in the treated group had delayed onset of CVD and the treatment could benefit specific groups, including smokers, individuals on antihypertensive medication, and older adults. However, among men there was no statistically significant association and HTE.
Conclusion
The study highlights the interconnectedness of SDoH and their greater impact on women's CVD risk compared to men.
期刊介绍:
Archives of Gerontology and Geriatrics provides a medium for the publication of papers from the fields of experimental gerontology and clinical and social geriatrics. The principal aim of the journal is to facilitate the exchange of information between specialists in these three fields of gerontological research. Experimental papers dealing with the basic mechanisms of aging at molecular, cellular, tissue or organ levels will be published.
Clinical papers will be accepted if they provide sufficiently new information or are of fundamental importance for the knowledge of human aging. Purely descriptive clinical papers will be accepted only if the results permit further interpretation. Papers dealing with anti-aging pharmacological preparations in humans are welcome. Papers on the social aspects of geriatrics will be accepted if they are of general interest regarding the epidemiology of aging and the efficiency and working methods of the social organizations for the health care of the elderly.