Association Between Neighborhood-Level Social Vulnerability and Hypertension Outcomes

Background: Neighborhood-level social vulnerability is associated with hypertension prevalence and severity and with cardiovascular complications in conditions other than hypertension, but its association with cardiovascular complications in patients with hypertension is understudied. Objectives: The aim of the study was to examine how the neighborhood-level social vulnerability index (SVI) influences cardiovascular outcomes in a large, diverse cohort of patients with hypertension. Methods: We used electronic health data to examine the association between census tract-level rankings for the SVI with a composite endpoint of incident myocardial infarction, congestive heart failure, or stroke. Results: In a longitudinal cohort of 330,972 patients with hypertension followed for a median of 6.6 years, the neighborhood-level SVI was significantly associated with the composite endpoint after adjustment for demographics, baseline body mass index and blood pressure (BP), and comorbidities (HR for quartile 4 [most disadvantaged group] vs quartile 1 = 1.31 [95% CI: 1.25-1.38], P < 0.001). Patients living in quartile 4 SVI areas had a significantly lower BP control rate compared with patients living in quartile 1 SVI areas (70.3% vs 74.8%, P < 0.001). Patients living in SVI quartile 4 areas were disproportionately Black (53.8%). Compared with the White race, the Black race was negatively associated with the composite outcome after adjustment for the SVI quartile, and other clinical factors (HR: 0.89 [95% CI: 0.86-0.92], P < 0.001). Conclusions: Neighborhood-level social vulnerability was strongly associated with adverse cardiovascular outcomes and poorer BP control and may be a driver of racial disparities in hypertension. These findings highlight the potential of leveraging social vulnerability indices for tailored interventions in hypertension management.