Neighborhood disadvantage and cardiovascular health in early adolescents in the United States

Adolescence is a critical period during which exposures to cardiovascular disease risk factors and related pathophysiologic changes begin. Yet neighborhood-level factors shaping cardiovascular health from adolescence onward remain understudied. The American Heart Association's Life's Essential 8 (LE8) is a composite cardiovascular health score, encompassing diet, physical activity, body mass index, blood pressure, and other factors. Area Deprivation Index (ADI), Social Vulnerability Index (SVI), and Childhood Opportunity Index (COI) estimate neighborhood disadvantage. This study examines associations between neighborhood disadvantage and LE8 cardiovascular risk factors in early adolescents. We analyzed data from the Adolescent Brain Cognitive Development (ABCD) Study, including 8,160 early adolescents with behavioral subcomponent scores and 1,125 with overall LE8 and health factors subcomponent scores. Neighborhood disadvantage indices (ADI, SVI, COI) were derived from geospatial data. Multivariable linear regression models assessed associations between ADI, SVI, and COI at baseline (2016-2018) and LE8 scores at Year 2 (2018-2020) and Year 3 (2019-2021), adjusted for age, sex, and race/ethnicity. Higher neighborhood disadvantage was associated with lower (less healthy) LE8 cardiovascular health scores in early adolescents, driven mainly by behavioral factors. Overall LE8 scores were 9.45 points lower for the most deprived ADI quintile (95% CI: -11.86, -7.05; p<0.001), 6.95 points lower for the most vulnerable SVI quintile (95% CI: -9.09, -4.82; p<0.001), and 8.45 points lower for the lowest opportunity COI quintile (95% CI: -10.77, -6.12; p<0.001). Higher neighborhood deprivation was associated with poorer LE8 cardiovascular health scores in early adolescence.