Abstract P261: Associations Between Adolescent Social Determinants and Adult Cardiovascular Health in the Add Health Cohort

Introduction: Hypertension is the leading risk factor for cardiovascular disease in the US. Individual social determinants of health (SDoH; e.g., housing and healthy food availability) are associated with hypertension in cross-sectional samples. However, there is a need to better understand how the social environment during youth impacts future hypertension risk to identify targets for primordial prevention and reduce health disparities. Objective: This study aimed to identify whether patterns of SDoH during adolescence were associated with hypertension risk during adulthood in a nationally representative sample. Methods: This analysis utilized public-use data from the National Longitudinal Study of Adolescent to Adult Health (Add Health) waves I and V (n=1,703). Using the Healthy People 2030 Framework, proxy measures for each domain of SDoH were identified from adolescent survey data (Wave I, age range 12-19 years). Blood pressure (BP) from in-home assessments (Wave V, age range age 32-42 years) was categorized as ‘normal’, ‘elevated’, or ‘hypertensive’ by ACC/AHA criteria. K-metoid (PAM) cluster analysis and assessment of silhouette width identified clusters of participants with similar patterns of SDoH during youth. Multinomial logistic regressions with bootstrapping estimated the odds of BP category membership relative to cluster membership. Models controlled for body mass index, smoking, age, sex, race, ethnicity, and medications. Analyses accounted for the complex sampling design, including appropriate Wave V weighting factors. Results: Three clusters were identified with distribution among ‘normal’, ‘elevated’, and ‘hypertensive’ BP categories, respectively, as: Cluster 1 (n=715), 40.3%, 12.3%, and 47.4%, Cluster 2 (n=499) 37.0%, 11.3%, and 51.7%, and Cluster 3 (n=489) 33.7%, 10.9%, and 55.4%. Primary differences among clusters included more frequent history of physical examinations in Cluster 1 vs. 2 and 3, and Cluster 2 vs. 3, greater feelings of safety in school and closeness to people at school in Cluster 2 vs. 1 and 3, and greater perceived prejudice at school in Cluster 1 vs. 2 and Cluster 2 vs. 3 (all p<0.05). In fully adjusted models, participants in Cluster 3 had greater odds of being hypertensive than those in Cluster 1 (OR: 1.45, 95% CI: 1.02, 2.08). Black or African American participants had greater odds of elevated (OR: 2.53, 95% CI: 1.56, 4.12) or hypertensive (OR: 2.22, 95% CI: 1.58, 3.11) BP, relative to whites. Females had lower odds of elevated (OR: 0.56, 95% CI: 0.34, 0.91) or hypertensive (OR: 0.32, 95% CI: 0.23, 0.45) BP, relative to males. Conclusions: SDoH during adolescence, specifically health care access and quality, may be associated with cardiovascular health during adulthood. Future research that includes more direct assessments of each SDoH domain across the lifespan will help to identify interventional targets for primordial prevention.