MEETING THE PREVENTATIVE CARE NEEDS OF OLDER AMERICANS: IDENTIFYING KEY SOCIAL RISK FACTORS FOR CARDIOVASCULAR DISEASES

Background: Preventive medicine recommendations targeting cardiovascular health in older adults are scarce. A main obstacle towards generating preventive recommendations targeting older adults is the exclusion of older adults from randomized clinical trials and the subsequent evidence gaps regarding cardiovascular health determinants in American older adults. Objective: This research aims to identify key social risk factors for cardiovascular health to better inform preventive medicine recommendations for American older adults. Methods: Participants (N=7,197) were drawn from the Round 1 of the National Health and Ageing Health Study (NHATS 2011), a prospective nationally representative panel study of Medicare beneficiaries older than 65 years. To measure cardiovascular health, cardiovascular risk factors and diagnosed diseases were combined to calculate the Risk of a Cardiovascular Event score (ROCE). The ROCE score combines cardiovascular risk factors (HBP, diabetes, abdominal obesity, depressive symptoms, and smoking habits) and the presence or history of cardiovascular and respiratory diseases (myocardial infarction, heart disease including angina or congestive heart failure, stroke and/or emphysema, asthma, or chronic bronchitis). Based on their ROCE, participants were classified as low, moderate or high risk of a cardiovascular event. Perceived neighborhood social cohesion (PNSC) was measured using a self-reported scale, and street disorder was assessed by the NHATS interviewer. Results: After adjusting for sociodemographic factors, baseline health status and healthcare utilization, low perceived level of neighborhood social cohesion (PNSC) and a high level of street disorder were associated with higher likelihood of belonging to the high risk ROCE group. PNSC was categorized in 7 levels: from lowest level of social cohesion (score 6) to highest level, with score 0 which was the reference category. When compared with the highest or “perfect” PNSC, the lowest score (6) is associated with 44% higher chance of belonging to the high-risk group of ROCE (p= 0.037), score 5 is associated with 55 % increase (p=0.009), score 4 is associated with 42% increased odds (p= 0.006), score 3 is associated with 18% increase (p=0.052), scores 2 with 13% increase (p=0.198) and, finally score 1 showed no increase (p= 0.571). Regarding street disorder, the presence of litter, graffiti or vacant houses in the neighborhood is associated with 25% (p=0.061) higher chance of being in the increase in the high-risk group of ROCE. When the PNSC association was studied with each risk factor and cardiovascular disease it was observed that low PNSC is associated with increased risk of reporting diabetes [OR=1.37 p<0.01], tobacco use [OR=1.43 p<0.05], depressive symptoms [OR= 1.43 p<0.01 ], heart disease [OR=1.22 p<0.1], heart attack [OR=1.30 p<0.1], stroke [OR=1.29 p<0.1] and, lung disease[OR= 1.38 p<0.01]. Regarding street disorder, there was a significant association with increased odds of reporting lung disease [OR=1.52 p