Social Determinants of Health, Depression, and Cardiovascular Health Among Veterans and Civilians: Insights From the 2013-2018 and 2021-2023 National Health and Nutrition Examination Survey.

INTRODUCTION

Emerging evidence supports the relationship among social determinants of health, depression symptoms, and cardiovascular health. Veterans have a disproportionate prevalence of cardiovascular disease and depression, social determinants of health concerns related to socioeconomic status, and challenges with access to healthcare. This study aimed to examine associations of social determinants of health and depression symptoms with cardiovascular health among civilians and veterans and assessed whether these associations differed between the 2 groups.

METHODS

Our cross-sectional analysis used 2013-2018 and 2021-2023 National Health and Nutrition Examination Survey data on participants aged 20 years or older without cardiovascular disease. Social determinants of health included demographic characteristics, socioeconomic factors, and access to health care. We used the Patient Health Questionnaire-9 to assess the severity of depression and dichotomized scores as 0 to 5 symptoms (no depression) or 5 or more symptoms (mild to severe depression). We quantified cardiovascular health using Life's Essential 8 scoring metric (scored from 0 to 100, with higher scores indicating better health status). We applied sample weights in multiple linear regressions.

RESULTS

Among 11,396 participants, 10,470 were civilians (mean age, 46 y; 55% female) and 926 were veterans (mean age, 56 y; 10% female). Mean cardiovascular health score was 71 among civilians and 67 among veterans. Veterans were more likely to have some college, higher financial status, and access to health care. Among both civilians and veterans, poorer cardiovascular health was associated with older age, identifying as non-Hispanic Black or as "other" or multiracial, lower education, lower financial status, and depression symptoms. These associations were more pronounced among veterans who identify as members of racial and ethnic minority populations or have lower financial status.

CONCLUSION

The magnitude of the links between cardiovascular health and some social determinants of health varied by veteran status, indicating that varied factors may influence health disparities in each group and underscoring the need for tailored strategies to address them.