In California, where cardiovascular disease remains the leading killer of adults, new research shows that where people live and their race or ethnicity continue to shape who dies prematurely from heart disease and stroke. The study examined more than 615,000 cardiovascular deaths among adults ages 18 and older between 2015 and 2021, spanning the years before and during the COVID-19 pandemic.
Researchers used the Healthy Places Index, a composite measure of 23 neighborhood conditions including economic security, education, housing, transportation, environmental pollution, social capital, the built environment, and access to health care. They found that cardiovascular mortality rates were inversely associated with Healthy Places Index scores: death rates fell by 5.4 deaths per 100,000 with each step up the index. Before the pandemic, adults living in the most disadvantaged neighborhoods had a cardiovascular mortality rate 1.77 times higher than those in the most advantaged areas, with even steeper gaps for ischemic and hypertensive heart disease.
The pandemic halted years of improvement in ischemic heart disease mortality and intensified rising deaths from hypertensive heart disease and stroke, but it did not erase the underlying social gradient. Within each racial and ethnic group, differences in cardiovascular mortality between the most and least advantaged neighborhoods were larger than the differences between racial and ethnic groups themselves, underscoring how racism and area-based socioeconomic conditions interact.
The authors estimate that 28% of cardiovascular deaths were attributable to the distribution of social determinants of health, highlighting what they call “untapped opportunities” to use neighborhood-level equity metrics in surveillance, healthcare, and policies aimed at eliminating racial and socioeconomic disparities in cardiovascular mortality.
See: “Race and Neighborhood Social Determinants of Cardiovascular Disease Mortality in California Adults Before and During the COVID-19 Pandemic” (July 26, 2025)
