Social Determinants of Health and Cardiovascular Disease: Current State and Future Directions Towards Healthcare Equity

Mohammad Hashim Jilani, Zulqarnain Javed, Tamer Yahya, Javier Valero-Elizondo, Safi U. Khan, Bita Kash, Ron Blankstein, Salim S. Virani, Michael J. Blaha, Prachi Dubey, Adnan A. Hyder, Farhaan S. Vahidy, Miguel Cainzos-Achirica, Khurram Nasir

Research output: Contribution to journalReview articlepeer-review

Abstract

Purpose of Review: We sought to examine the role of social and environmental conditions that determine an individual’s behaviors and risk of disease—collectively known as social determinants of health (SDOH)—in shaping cardiovascular (CV) health of the population and giving rise to disparities in risk factors, outcomes, and clinical care for cardiovascular disease (CVD), the leading cause of death in the United States (US). Recent Findings: Traditional CV risk factors have been extensively targeted in existing CVD prevention and management paradigms, often with little attention to SDOH. Limited evidence suggests an association between individual SDOH (e.g., income, education) and CVD. However, inequities in CVD care, risk factors, and outcomes have not been studied using a broad SDOH framework. Summary: We examined existing evidence of the association between SDOH—organized into 6 domains, including economic stability, education, food, neighborhood and physical environment, healthcare system, and community and social context—and CVD. Greater social adversity, defined by adverse SDOH, was linked to higher burden of CVD risk factors and poor outcomes, such as stroke, myocardial infarction (MI), coronary heart disease, heart failure, and mortality. Conversely, favorable social conditions had protective effects on CVD. Upstream SDOH interact across domains to produce cumulative downstream effects on CV health, via multiple physiologic and behavioral pathways. SDOH are major drivers of sociodemographic disparities in CVD, with a disproportionate impact on socially disadvantaged populations. Efforts to achieve health equity should take into account the structural, institutional, and environmental barriers to optimum CV health in marginalized populations. In this review, we highlight major knowledge gaps for each SDOH domain and propose a set of actionable recommendations to inform CVD care, ensure equitable distribution of healthcare resources, and reduce observed disparities.

Original languageEnglish (US)
Article number55
JournalCurrent atherosclerosis reports
Volume23
Issue number9
DOIs
StatePublished - Sep 2021
Externally publishedYes

Keywords

  • Cardiovascular disease
  • Health disparities
  • Social determinants of health

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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