PROJECT SUMMARY/ABSTRACT Deaths from cardiovascular disease (CVD) have begun to increase in the US after decades of decline. Although the reasons underlying this increase in CVD deaths are unclear, the prevention, detection, and optimal treatment of CVD risk factors (i.e., diabetes and hypertension) will be essential for preventing any further increases in CVD mortality. Currently, 14% of adults in the US have diabetes, of which 1 in 3 is undiagnosed, and 29% of adults have hypertension. However, stark disparities exist in the CVD risk factor burden, particularly by social determinants of health. These determinants are key contributors to the development of diabetes and hypertension. Yet, they have largely been omitted from clinical practice and decision-making. There is increasing awareness of the influence of social determinants on health outcomes, but it is not clear exactly which factors should be assessed or how to integrate this information into current practice. Social determinants of health are extensive, so it is important to characterize those that are likely to have the greatest influence on the prevention, treatment and control of diabetes and hypertension and may be used to inform the development of targeted programs and policies. We propose to investigate the community and individual social determinants that contribute to a greater burden of diabetes and hypertension in the southeastern US by leveraging national databases, the Medicare claims administrative database and the infrastructure of a prospective cohort study, the NIH-funded Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, that enrolled 30,239 middle-aged and older adults in 2003-07. We will build upon these resources to address the following aims: 1) determine the association of county-level social determinants of health with the county-level prevalence and incidence of diabetes and hypertension, separately, in the southeastern US; 2) evaluate the association of county-level social determinants of health with the county-level prevalence and incidence of diabetes and hypertension, separately, among older adults in the southeastern US using the Medicare database; and 3) evaluate the association of county-level and individual-level social determinants of health with individual-level prevalent and incident diabetes and hypertension, separately, among REGARDS participants in the southeastern US. This proposal will prioritize those social determinants of health that are associated with a greater burden of diabetes and hypertension in the southeastern US and help guide prevention programs and interventions to reduce this excess risk.