Social and Cardiovascular Risk Factors in Older Adults with Prediabetes
Dr. Leonard Egede, Dr. Rebekah Walker, and Dr. Obinna Ekwunife from the Department of Medicine at the University of Buffalo, NY, describe their research paper published in Volume 17, Issue 8, titled “Longitudinal relationship between social and CVD risk factors in older adults with prediabetes: the HRS 2006-2016.”
DOI - https://doi.org/10.18632/aging.206308
Transcript
Hello, this is Dr. Leonard Egede. I’m a professor of medicine and the chair of the Department of Medicine at University of Buffalo, and I’m excited today to share with you a paper that we published recently, titled “Longitudinal Relationship Between Social and CVD Risk Factors in Older Adults With Prediabetes: The Health and Retirement Study 2006 to 2016.”
My name is Rebekah Walker, and I am one of the co-authors on this paper. I am the division chief for our division of Population Health at the University of Buffalo. One of the reasons that we looked at this topic is because prediabetes is a growing public health challenge, and more than 96 million US adults are living with prediabetes. The older population in which one in two adults have prediabetes is particularly vulnerable because prediabetes is not just a precursor to diabetes itself, but significantly increases the risk of cardiovascular complications like high blood pressure, heart disease, and stroke. Despite this, we know far less about the social risk factors that shape cardiometabolic health outcomes. That gap is what motivated our study. We used the Health and Retirement Study data, a national representative survey of older adults, and we followed those adults, which were over 5,000 participants with prediabetes, from 2006 to 2016. Our goal was to examine how social and cardiovascular risk factors interact over time and to identify which social risk factors most consistently predicted worse cardiometabolic outcomes.
I am Obinna Ekwunife. I’m an assistant professor in the Department of Medicine and one of the authors in this paper. So why did we take on this topic? So first, because of the scale. Because with nearly half of the adults over 65 living with prediabetes, the potential impacts on individual families as well as the health system is really enormous. Second, because of inequity. Older adults already face barriers to assessing healthcare, and when you layer on social risk, like low income, limited education or poor insurance coverage, those barriers become even more daunting. And finally, because of opportunity. Prediabetes is modifiable. It is a stage where targeted intervention, if implemented effectively, can prevent progression to type two diabetes and reduce cardiovascular complications. We wanted to better understand where to focus those interventions.
Now, we’ll discuss our findings. And one of the most notable and somewhat surprising result was the role of education. As you would imagine of all these social risk factors we examined, limited education was the only one consistently associated with worse outcomes across all three cardiometabolic indicators: blood sugar, blood pressure, and cholesterol. This finding stood out even when we accounted for other risk factors like financial strain or lack of health insurance. Education seemed to have a powerful enduring influence shaping health literacy, income opportunities, job conditions, and even one’s ability to navigate complex health system.
Second, we found that economic hardship also mattered. Participants who reported difficulty paying bills or skipping medications because of cost had significantly worse cardiometabolic outcome. This underscores how financial insecurity undermines health, not just by limiting access to medications, but also shaping everyday decisions about food, housing, and other necessities.
Figure 3. Fully adjusted mixed effects linear regression for relationship between social risk factors and cholesterol ratio. p-value <0.05; *p-value <0.01; *** p-value <0.001.
Now, what surprised us most in this analysis was how strongly education persisted as a predictor. We often think of financial strain or insurance status as the primary social risk. And indeed, they’re important, but education consistently showed up across every model we tested. This suggests that improving health outcomes may require more than addressing immediate access barriers. We need to think broadly about how lifelong educational opportunities, health literacy programs, and even adult education initiatives can impact health trajectories in later life.
So the next question is, where do we go from here? This study provides a strong evidence base for intervention research. Our next step is to design and test strategies that address these social risks in real world settings. For example, simplifying health education materials for people with limited formal education, developing peer support and navigation programs to help older adults manage their conditions and connect with resources, or partnering with community-based organizations to provide financial navigation, food support, or transportation assistance.
We can also advocate for policy changes. For instance, incorporating pre-diabetes into Medicaid waiver programs that currently support services, like nutrition counseling, housing, or transportation. By doing so, we can align social supports with medical care and make it easier for older adults to prevent progression to diabetes and cardiovascular disease. Finally, we can extend this work by building community-based models for screening, referral and enrollment into the diabetes prevention program, especially for underserved populations. This aligns with our broader research agenda at the University of Buffalo to reduce cardiometabolic health disparities.
In summary, we use data from the Health and Retirement Study that included 5,086 adults aged 50 and older with pre-diabetes and evaluated five social risk domains, including economic stability, built environment, education, healthcare, and social context. And we found that most of the social risk factors had significant impact on CVD risk factors, with low educational attainment being a consistent risk factor across all CVD risk factors. This study highlights the significant influence of social risk factors on cardiovascular health outcomes in older adults with pre-diabetes and underscores the need for targeted interventions to address social risk factors in older adults with pre-diabetes. Thank you.
