How Public County Data Can Guide Equitable Cardiovascular–Kidney–Metabolic Prevention in California

Cardiovascular–kidney–metabolic (CKM) prevention requires both clinical risk assessment and practical access to sustained care. We combined published clinical evidence with publicly available aggregate data for California’s 58 counties to examine how economic deprivation and insurance gaps could inform prevention planning when the state’s distribution of CKM stages and arrhythmias is unknown. American Community Survey estimates identified 7.54 million residents below 150 percent of poverty in 2020–24. Separate 2023 estimates identified 567,018 uninsured adults ages 18–64 at or below 138 percent of poverty. The two measures mapped differently: economic disadvantage was concentrated in several inland and northern counties, whereas the highest low-income uninsured percentages occurred in the coastal counties of Monterey, Ventura, and Santa Barbara. A third dimension, absolute volume, pointed elsewhere again: Los Angeles accounted for 30.8 percent of the statewide low-income uninsured population. We present an explicitly defined, single-indicator economic-deprivation percentile, not an official Social Vulnerability Index, and we keep five arrhythmia outcomes clinically distinct. These maps cannot establish CKM prevalence or progression. They support a policy approach that separates outreach intensity, service capacity, and individual clinical eligibility, finances the specific barriers that prevent completed care, and evaluates programs on completed assessment and patient-important outcomes rather than on detection volume.