Association of Environmental Justice (EJI) and Social Vulnerability (SVI) Indices with Cardiovascular Outcomes in Primary Proteinuric Glomerulopathies

Background: Social and environmental factors shape cardiovascular risk, however their impact in glomerular disease is understudied despite high cardiovascular disease (CVD) burden in these individuals. Methods: Participants with MCD, FSGS, MN, or IgAN enrolled in the Cure Glomerulonephropathy study with geocode data and >1 visit were included. SVI and EJI scores were assigned by geocode (ATSDR database). Generalized Estimating Equation models analyzed longitudinal associations between SVI/EJI and outcomes: blood pressure (BP), hypertension (2017 AAP, 2017 AHA), lipids and dyslipidemia (triglycerides or TG≥150 mg/dL, HDL≤40 mg/dL, or LDL≥160 mg/dL. BP was indexed (BPi) to 95th %ile in children <13 years or 130/80 mmHg in children ≥13 years. Cox regressions analyzed associations between SVI/EJI and time to total CVD event (stroke, heart failure, coronary artery disease) in adults. Models were adjusted for age, sex, race, BMI Z-score, diagnosis, follow-up time, eGFR, UPCR, edema, and medications. Results: Among 3430 participants (2246 adults, mean age 46±16y; 1184 children, mean age 10±5y), baseline EJI/SVI were not associated with BP status. Longitudinally, worse EJI in adults was associated with higher systolic BP, lower HDL, and increased odds of dyslipidemia (Fig 1). In children, worse EJI was associated with higher systolic and diastolic BPi while worse SVI was associated with higher DBPi, lower TG, and higher HDL over time (Fig 1). Both EJI and SVI predicted increased risk of a CVD event. Conclusion: EJI and SVI are independently associated with worse CVD outcomes over time in proteinuric glomerulopathies. Future studies are needed to determine how individual social and environmental factors contribute to negative CVD outcomes. Funding: NIDDK Support