Social Determinants of Health and Cardiovascular Risk among Adults with Diabetes: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study (Diabetes Metab J 2024;48:1073-83)

Lisa Zhang; Monika M. Safford

doi:10.4093/dmj.2025.0383

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Response Social Determinants of Health and Cardiovascular Risk among Adults with Diabetes: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study (Diabetes Metab J 2024;48:1073-83): Lisa Zhang¹, Monika M. Safford²; Diabetes & Metabolism Journal 2025;49(4):910-911.
DOI: https://doi.org/10.4093/dmj.2025.0383
Published online: July 1, 2025

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¹Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA

²Department of Medicine, Weill Cornell Medical College, Cornell University, New York, NY, USA

Corresponding author: Lisa Zhang

Department of Pediatrics, Columbia University Irving Medical Center, 3959 Broadway New York, NY 10032, USA E-mail: tzm9001@nyp.org

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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See the letter "Social Determinants of Health and Cardiovascular Risk among Adults with Diabetes: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study (Diabetes Metab J 2024;48:1073-83)" on page 906.

We appreciate the thoughtful comments by the letter writer on our recently published article ‘Social determinants of health and cardiovascular risk among adults with diabetes: the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study’ [1]. We thank the editor for the opportunity to respond and further discuss our work.

We fully agree that social determinants of health (SDOH) play a critical role in patient outcomes, and their integration into clinical management is essential for assessing and improving health outcomes. The letter writer raises several important challenges related to SDOH analysis, which we acknowledge as limitations of our study. For example, the letter writer aptly points out that in reality, SDOH exist on a spectrum, rather than the dichotomous ‘present’ or ‘absent’ variables in our study. We agree that SDOH are multifacted and complex; however, the available variables are limited in nature, which is a common limitation in SDOH research.

The letter writer also notes that our study did not employ a weighted analysis, which could have provided more precise insights into the impact of SDOH. We recognize this as a limitation in the risk prediction of our work. However, our primary goal was to offer a practical and simple framework for clinicians to apply SDOH considerations in diabetes management, a strategy we have employed in past Reasons for Geographic and Racial Differences in Stroke (REGARDS) work as well [2,3]. A weighted approach, while methodologically valuable, would have added complexity that may limit clinical utility. Our use of a simple count variable was intended to help clinicians leverage readily available patient information to guide care decisions.

We also agree that the influence of SDOH is an important aspect of diabetes management and recognize that our study based in the United States needs caution when being generalized to other regions, where cultural and social factors vary. The letter writer also aptly notes that SDOH could affect the incidence of diabetes, which would be a very interesting area for study in our future work.

We appreciate the opportunity to engage in this important dialogue and hope that our response further emphasizes the need for continued research and thoughtful integration of SDOH into clinical care and public health strategies.

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CONFLICTS OF INTEREST

No potential conflict of interest relevant to this article was reported.

REFERENCES

1. Zhang L, Reshetnyak E, Ringel JB, Pinheiro LC, Carson A, Cummings DM, et al. Social determinants of health and cardiovascular risk among adults with diabetes: the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. Diabetes Metab J 2024;48:1073-83.PubMed PMC
2. Pinheiro LC, Reshetnyak E, Akinyemiju T, Phillips E, Safford MM. Social determinants of health and cancer mortality in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort study. Cancer 2022;128:122-30.Article PubMed PDF
3. Sterling MR, Ringel JB, Pinheiro LC, Safford MM, Levitan EB, Phillips E, et al. Social determinants of health and 30-day readmissions among adults hospitalized for heart failure in the REGARDS study. Circ Heart Fail 2022;15:e008409.Article PubMed

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Social Determinants of Health and Cardiovascular Risk among Adults with Diabetes: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study (Diabetes Metab J 2024;48:1073-83)

Diabetes Metab J. 2025;49(4):910-911. Published online July 1, 2025

DOI: https://doi.org/10.4093/dmj.2025.0383

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Social Determinants of Health and Cardiovascular Risk among Adults with Diabetes: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study (Diabetes Metab J 2024;48:1073-83)

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Zhang L, Safford MM. Social Determinants of Health and Cardiovascular Risk among Adults with Diabetes: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study (Diabetes Metab J 2024;48:1073-83). Diabetes Metab J. 2025;49(4):910-911.

DOI: https://doi.org/10.4093/dmj.2025.0383.

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