Impact of social determinants of health on cardiovascular disease prevention

Abstract

Purpose of reviewSocial determinants of health (SDOH) describe conditions in one's environment that have an impact on health, quality-of-life, outcomes, and risks. These include income, education, employment, culture, language, healthcare access, social support, race, ethnicity, structural racism, discrimination, social support, neighborhood characteristics, and others. SDOH manifest as persistent inequalities in cardiovascular risk factors and disease, and, therefore, contribute to cardiovascular disease (CVD)-related morbidity and mortality. This article reviews how SDOH affect CVD risk and the role they play in CVD prevention. Recent findingsThe 2019 American College of Cardiology/American Heart Association (AHA) guideline on the primary prevention of CVD recommends that clinicians evaluate SDOH on an individual basis to inform treatment decisions for CVD prevention efforts. Recent evidence shows that low socioeconomic status, adverse childhood experiences, less social support, reduced health literacy, and limited healthcare access are associated with higher CVD risk and poorer health outcomes. A 2020 AHA statement emphasized the role of structural racism as a fundamental driver of health disparities. The AHA 2030 Impact Goals state a desire to achieve health equity by identifying and removing barriers to healthcare access and quality. SummarySDOH affect CVD prevention efforts. The SDOH that affect cardiovascular risk factors, diseases, and outcomes are complex and intersect. Addressing them can be challenging and will require a multilevel and multidisciplinary approach, involving public health measures, changes in health systems, team-based care, and dismantling of structural racism. More studies are needed to investigate the effect of interventions that improve SDOH and prevent CVD or lower CVD risk. Keywords cardiovascular disease prevention, social determinants of health, socioeconomic factors, structural racism ], and since that time there has been increasing recognition of their importance in the successful implementation of guideline-directed preventive care.

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“…Thus, co-occurring medical disorders cannot fully account for the greater severity of COVID-19 disease in people with psychiatric disorders. Third, severe mental illness is often linked with lower socioeconomic status (SES) [ 153 – 155 ], which is in turn associated with reduced access to health care [ 156 , 157 ]. However, again this factor is unlikely to fully explain the away the findings as population-based studies that did not limit participants to those treated in hospitals, were the focus of at least one meta-analysis [ 141 ].…”

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“…Health disparities are driven by a complex web of economic, social, cultural, and medical influences [1][2][3][4], the details of which may vary from location to location, but the consequences uniformly crippling. In the Arkansas Delta Region (ADR) economic prosperity remains largely elusive due to struggles providing the infrastructure, skilled workforce, quality of life, and good-paying jobs needed to maintain and grow the local economy and enabling households to generate enough income to support their families.…”

Social Determinants of Health on Cardiovascular Disease Prevention in Special Populations: An Overview

“…Therefore, it is essential to highlight SDoH to prevent CVD, including socioeconomic position (SEP), race/ethnicity, social support, culture, and access to health care. SEP is one of the most important SDoH with a high impact on the risk of CVD [3,7,9]. Income, education, and occupational status are the three leading indicators of SEP in the risk of CVD and should be assessed concomitantly.…”

“…These factors include income, education, employment, culture, language, healthcare access, social support, race, ethnicity, structural racism, discrimination, neighborhood characteristics, and other variables as defined by the Centers for Disease Control (CDC) and the World Health Organization (WHO) [1,2]. SDoH manifests as persistent inequalities in cardiovascular disease (CVD) risk factors, contributing to increased rates of morbidity and mortality related to this condition [3].…”