Year of Publication



Public Health

Date Available


Degree Name

Master of Public Health (M.P.H.)

Committee Chair

Mary E. Lacy, PhD

Committee Member

Anna Kucharska-Newton, PhD

Committee Member

W. Jay Christian, PhD

Committee Member

Rhiannon Simon, MPH


Background: Acute myocardial infarction (AMI) is a leading contributor to cardiovascular mortality and is associated with social vulnerability. Prior studies have established an association between social vulnerability and AMI so that higher levels of vulnerability are correlated with higher rates of AMI. Kentucky has a high burden of AMI and elevated levels of social vulnerability. However, the relationship between social vulnerability and AMI-related outcomes in Kentucky has not been fully explored. In this study, we examine the association of county-level social vulnerability index (SVI) with AMI hospitalization and mortality rates in Kentucky from 2016 to 2020.

Methods: Annual Kentucky county-level rates of AMI hospitalizations and deaths were obtained from the Centers for Disease Control and Prevention (CDC) and are presented as five-year age-adjusted rates. County-level SVI data were also obtained from the CDC including an overall SVI score as well as scores on each of the four SVI subcategory themes (socioeconomic status [SES], household characteristics, racial and ethnic minority status, and housing type and transportation) and scores on each theme-associated measure. Percentile ranking scores for overall SVI, the four SVI subcategory themes, and individual measures from select subcategory themes were presented as quartiles, with Quartile 1 (Q1) representing the least socially vulnerable counties and Quartile 4 (Q4) the most. Both unadjusted and adjusted linear regression models were used to examine the association of SVI with study outcomes.

Results: Compared to the least vulnerable counties (Q1), the most vulnerable counties (Q4) on the overall SVI measure had higher age-adjusted AMI hospitalization and mortality rates. In linear regression models simultaneously adjusting for the four SVI themes, SES was associated with increased AMI hospitalization rates, while racial and ethnic minority status was associated with decreased AMI hospitalization and mortality rates. In simple linear regression models, poverty, unemployment, and no high school diploma measures were associated with higher age-adjusted AMI hospitalization and mortality rates.

Conclusion: High AMI hospitalization and mortality rates were associated with high vulnerability on the overall SVI measure, SES and racial and ethnic minority status themes, and the poverty, unemployment, and no high diploma measures. County-level interventions targeting overall social vulnerability and low SES may reduce poor AMI outcomes in Kentucky.

Available for download on Monday, April 27, 2026

Included in

Epidemiology Commons