Manuscript Title: Social Determinants of Health and Cardiovascular Disease in Women with Polyendocrine metabolic ovarian syndrome.

Abstract

No studies have explored racial differences in atherosclerotic cardiovascular disease (ASCVD) in women with polyendocrine metabolic ovarian syndrome (PMOS), formerly polycystic ovary syndrome (PCOS). Compare ASCVD risk by race/ethnicity among women with PMOS and determine whether social determinants of health (SDoH) drive associations. Cohort study. Optum's de-identified Clinformatics® Data Mart Database (2000-2022). Women aged 18-50 with PMOS using PCOS ICD9/10 codes. Race/ethnicity was categorized as White, Black, Asian or Hispanic. None. Primary outcome was risk of composite ASCVD (coronary artery disease, cerebrovascular disease, peripheral artery disease). Secondary outcomes included each component. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated using cox proportional hazards models that were unadjusted (Model 1), adjusted for medical comorbidities (Model 2) and adjusted for comorbidities plus SDoH: homeownership, net worth and education (Model 3). The sample included 413,450 women with PMOS. Accounting for medical comorbidities (Model 2), Asian women with PMOS were at a lower risk for ASCVD compared to White women (aHR 0.65, 95%CI 0.56-0.74) and Black (aHR 1.10, 95%CI 1.02-1.19) and Hispanic women (aHR 1.21, 95%CI 1.12-1.29) were at a higher risk. After adjusting for SDoH (Model 3), the findings for Asian and Hispanic women remained significant whereas those for Black women did not. When looking at individual components of ASCVD, the higher risk for multiple components among Black women were no longer significant after controlling for SDoH. Racial differences exist in risk of ASCVD among women with PMOS.