Sex differences in the association between cumulative social risk and life’s essential 8 cardiovascular health scores in U.S. adults

Introduction: Cardiovascular health (CVH) disparities persist in the U.S., often shaped by social risk factors. However, few studies have examined how individual and cumulative social risks relate to CVH across sex. Methods: We analyzed cross-sectional data from the 2013-2023 National Health and Nutrition Examination Survey (NHANES). CVH was defined by Life's Essential 8 (LE8) which includes diet, physical activity, nicotine exposure, sleep, body mass index, blood lipids, blood glucose, and blood pressure. LE8 scores range from 0 to 100 and were categorized as low (<50), moderate (50-79), or high (≥80). Social risk was defined across six domains: low income, low education, minoritized race or ethnicity, single-living status, lack of health insurance, and unemployment, summed and categorized as 0, 1, 2, 3, or ≥4 risks. Weighted multinomial logistic regression models adjusted for age were used to estimate associations. Results: Among 21,625 adults (representing ≈245 million U.S. adults), the mean age was 46.4 years. Low education was associated with 2.34 times higher odds of low CVH in males (95% CI: 1.72-3.20) and 1.83 times higher odds in females (95% CI: 1.38-2.43). Low income was linked to 2.79 times higher odds of low CVH in females (95% CI: 2.08-3.75). Unemployment was associated with 2.56 times higher odds of low CVH in males (95% CI: 1.91-3.44). Adults with ≥4 social risks had 7.14 times higher odds of low CVH in females and 6.05 in males. Mean LE8 scores declined from 68.0 to 60.9 in females and from 67.2 to 60.3 in males over the decade. Conclusion: Individual and cumulative social risks were strongly associated with lower CVH, with women bearing a greater burden. These findings highlight the need for policies that address social factors to reduce sex-based disparities and improve CVH.