Clustering of Social Determinants of Health and Their Association With Adverse Cardiovascular Outcomes in Atrial Fibrillation

BACKGROUND: Individuals with atrial fibrillation remain at high risk for major adverse cardiovascular events despite advances in treatment. Social determinants of health (SDOH) are associated with cardiovascular outcomes, yet how these factors cluster to create distinct vulnerability profiles remains poorly understood. METHODS: Using UK Biobank data, we examined 15 SDOH indicators across economic, psychological, and neighborhood domains among 3842 participants with atrial fibrillation (35.1% female). Multigroup latent class analysis evaluated sex-based differences in vulnerability pattern distribution. Cox proportional hazards models assessed the association between identified SDOH clusters and composite cardiovascular outcomes comprising major adverse cardiovascular events and all-cause mortality. RESULTS: Five distinct SDOH vulnerability clusters were identified: (1) low vulnerability across all domains, (2) primarily economic vulnerability, (3) primarily neighborhood-related vulnerability, (4) economic and neighborhood vulnerability with favorable psychological conditions, and (5) high vulnerability across all domains. Men were more represented in advantaged profiles than women (Cluster 1: 37.0% versus 26.6%; Cluster 4: 25.3% versus 14.1%), and women showed the greatest representation in the highest vulnerability cluster (Cluster 5: 35.1% versus 25.2%). Compared with Cluster 1, Cluster 2 had a 30% higher risk (hazard ratio [HR], 1.30 [95% CI, 1.07-1.58]), Cluster 4 had 37% increased risk (HR, 1.37 [95% CI, 1.13-1.68]), and Cluster 5 more than twice the risk (HR, 2.05 [95% CI, 1.67-2.52]). CONCLUSIONS: Five distinct SDOH vulnerability patterns were identified among individuals with atrial fibrillation, with economic determinants as pivotal drivers of cardiovascular risk. These findings support incorporating comprehensive SDOH assessment into atrial fibrillation clinical management.