Research Paper|Volume 17, Issue 8|pp 2152—2166

Longitudinal relationship between social and CVD risk factors in older adults with prediabetes: the HRS 2006-2016

Obinna Ekwunife¹, Yilin Xu¹, Raphael Fraser¹, Jennifer Campbell¹, Rebekah J. Walker¹, David Jacobs², Leonard E. Egede¹

¹Division of Population Health, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, NY 14203, USA
²Division of Outcomes and Practice Advancement, Department of Pharmacy Practice, School of Pharmacy, University at Buffalo, Buffalo, NY 14214, USA

Received: March 27, 2025Accepted: July 1, 2025Published: August 26, 2025

https://doi.org/10.18632/aging.206308

Copyright: © 2025 Ekwunife et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Background: This study examines how multiple social risk factors influence cardiovascular disease (CVD) risk control over time in older adults with prediabetes using a nationally representative cohort.

Methods: Data from the Health and Retirement Study (HRS) included 5,086 U.S. adults aged 50+ with prediabetes. Five social risk domains (economic stability, environment, education, healthcare, and social context) were examined as independent variables, while CVD risk factors included glycemic control (HbA1c), systolic blood pressure (SBP), and cholesterol ratio (total cholesterol/high-density lipoprotein). Mixed-effects models assessed relationships between social risk factors and CVD outcomes, adjusting for age, gender, race, and marital status.

Results: The sample had an average age of 68.6 years, with 60.2% female, and 70.97% identifying as non-Hispanic Black. Average HbA1c was 5.7, SBP 129.4, and cholesterol ratio 3.85. Limited education was consistently associated with increased CVD risk—HbA1c (β = 0.03, 95% CI: 0.01–0.06, p < 0.001), SBP (β = 4.34, 95% CI: 2.96–5.71, p < 0.001), and cholesterol ratio (β = 0.08, 95% CI: 0.01–0.16, p < 0.05) —in the fully adjusted model. Medication cost-related non-adherence was significantly associated with higher HbA1c levels (β = 0.03, 95% CI: 0.002–0.06, p < 0.05). Difficulty paying bills and lack of health insurance were both significantly associated with higher cholesterol levels (β = 0.03, 95% CI: 0.002–0.06, p < 0.05) and (β = 0.22, 95% CI: 0.15–0.30, p < 0.001), respectively.

Conclusions: Social risk factors, particularly limited education, significantly impact CVD risk in older adults with prediabetes.