Associations of Sociodemographic and Neighborhood Vulnerability With Cardiovascular Health in Midlife Women in the United States.

Authors

Zhi Lin, Sheryl L Rifas-Shiman, Wei Perng, Li Yi, JoAnn E Manson, Hadine Joffe, Marie-France Hivert, Jorge E Chavarro, Izzuddin M Aris

Published in

Circulation. Population health and outcomes. Pages e013433. Jul 17, 2026. Epub Jul 17, 2026.

Abstract

Many women have suboptimal cardiovascular health (CVH), which declines during midlife. Few studies have characterized CVH across the menopausal transition or identified its sociodemographic and neighborhood determinants.
We analyzed a prospective cohort of women in eastern Massachusetts enrolled during pregnancy (1999-2002) and followed to midlife (2019-2024). Exposures included household income, education, race and ethnicity, and neighborhood Social Vulnerability Index (categorized from very low [<20th percentile] to very high [≥80th percentile]; higher categories=greater neighborhood vulnerability). Women self-reported their menopause status using questionnaires. Using Life's Essential 8, we derived CVH scores (0-100 points; higher score=better CVH) at 3-, 8-, 13-, 18-, and 23-year follow-up visits. Linear spline mixed-effect models examined associations of sociodemographics and neighborhood Social Vulnerability Index with differences in CVH across different menopause stages (premenopause, perimenopause, and postmenopause).
Among 1200 women (mean enrollment age, 32.1 years; 67.5% Non-Hispanic White), 15.4% had household incomes ≤$40 000/y, 8.8% had ≤high school education, and 17.4% resided in very high Social Vulnerability Index neighborhoods. After covariate adjustment, women with lower income, lower education, or identifying as Non-Hispanic Black exhibited lower CVH across follow-up. Independent of individual sociodemographics, continued residence in vulnerable neighborhoods over time was associated with lower CVH and unfavorable CVH trajectories across follow-up. For example, residence in very high (versus very low) Social Vulnerability Index neighborhoods from enrollment to 3-year follow-up corresponded to mean CVH differences of -6.7 (95% CI, -12.3 to -1.2) at 3-year, -9.8 (95% CI, -15.6 to -4.0) at 8-year, -8.9 (95% CI, -13.9 to -3.9) at 13-year, -6.7 (95% CI, -12.9 to -0.5) at 18-year, and -7.2 (95% CI, -12.5 to -1.9) at 23-year follow-up, and with faster CVH score decline during premenopause (-0.62 points/y; 95% CI, -1.22 to -0.02).
Women from disadvantaged sociodemographic backgrounds or residing in vulnerable neighborhoods exhibit poorer CVH across the menopausal transition, highlighting opportunities to optimize long-term CVH and mitigate cardiovascular disease risk.

PMID:
42464805
Bibliographic data and abstract were imported from PubMed on 17 Jul 2026.

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