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Review
. 2018 May 15;137(20):2166-2178.
doi: 10.1161/CIRCULATIONAHA.117.029652.

Socioeconomic Status and Cardiovascular Outcomes: Challenges and Interventions

William M Schultz  1 , Heval M Kelli  2 , John C Lisko  1 , Tina Varghese  1 , Jia Shen  2 , Pratik Sandesara  2 , Arshed A Quyyumi  2 , Herman A Taylor  3 , Martha Gulati  4 , John G Harold  5 , Jennifer H Mieres  6 , Keith C Ferdinand  7 , George A Mensah  8 , Laurence S Sperling  9
Affiliations
Review

Socioeconomic Status and Cardiovascular Outcomes: Challenges and Interventions

William M Schultz et al. Circulation. .

Abstract

Socioeconomic status (SES) has a measurable and significant effect on cardiovascular health. Biological, behavioral, and psychosocial risk factors prevalent in disadvantaged individuals accentuate the link between SES and cardiovascular disease (CVD). Four measures have been consistently associated with CVD in high-income countries: income level, educational attainment, employment status, and neighborhood socioeconomic factors. In addition, disparities based on sex have been shown in several studies. Interventions targeting patients with low SES have predominantly focused on modification of traditional CVD risk factors. Promising approaches are emerging that can be implemented on an individual, community, or population basis to reduce disparities in outcomes. Structured physical activity has demonstrated effectiveness in low-SES populations, and geomapping may be used to identify targets for large-scale programs. Task shifting, the redistribution of healthcare management from physician to nonphysician providers in an effort to improve access to health care, may have a role in select areas. Integration of SES into the traditional CVD risk prediction models may allow improved management of individuals with high risk, but cultural and regional differences in SES make generalized implementation challenging. Future research is required to better understand the underlying mechanisms of CVD risk that affect individuals of low SES and to determine effective interventions for patients with high risk. We review the current state of knowledge on the impact of SES on the incidence, treatment, and outcomes of CVD in high-income societies and suggest future research directions aimed at the elimination of these adverse factors, and the integration of measures of SES into the customization of cardiovascular treatment.

Keywords: cardiovascular diseases; epidemiology; risk factors; social class; social determinants of health.

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Conflict of interest statement

Disclosures

The authors have no financial conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Markers of socioeconomic status.
Figure 2
Figure 2
Cardiovascular disease death rates in individuals aged ≥35, by county between 2013-2015. Rates are spatially smoothed to enhance the stability of rates in counties with small populations. Data sources are the National Vital Statistics System and National Center for Health Statistics. This map was created using the Interactive Atlas of Heart Disease and Stroke, a website developed by the Centers for Disease Control and Prevention, Division for Heart Disease and Stroke Prevention.
Figure 3
Figure 3
Association between low socioeconomic status, cardiovascular risk factors, cardiovascular disease, and interventions. CVD, cardiovascular disease; SES, socioeconomic status.
Figure 4
Figure 4
Interventions at the community, government, healthcare systems and individual level should be targeted equally in efforts to reduce disparities in heath.
See this image and copyright information in PMC

References

    1. Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R, de Ferranti SD, Floyd J, Fornage M, Gillespie C, Isasi CR, Jimenez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Mackey RH, Matsushita K, Mozaffarian D, Mussolino ME, Nasir K, Neumar RW, Palaniappan L, Pandey DK, Thiagarajan RR, Reeves MJ, Ritchey M, Rodriguez CJ, Roth GA, Rosamond WD, Sasson C, Towfighi A, Tsao CW, Turner MB, Virani SS, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P, American Heart Association Statistics C and Stroke Statistics S Heart Disease and Stroke Statistics-2017 Update: A Report From the American Heart Association. Circulation. 2017;135:e146–e603. - PMC - PubMed
    1. Franks P, Winters PC, Tancredi DJ, Fiscella KA. Do changes in traditional coronary heart disease risk factors over time explain the association between socio-economic status and coronary heart disease? BMC Cardiovasc Disord. 2011;11:28. - PMC - PubMed
    1. Stringhini S, Carmeli C, Jokela M, Avendaño M, Muennig P, Guida F, Ricceri F, d’Errico A, Barros H, Bochud M, Chadeau-Hyam M, Clavel-Chapelon F, Costa G, Delpierre C, Fraga S, Goldberg M, Giles GG, Krogh V, Kelly-Irving M, Layte R, Lasserre AM, Marmot MG, Preisig M, Shipley MJ, Vollenweider P, Zins M, Kawachi I, Steptoe A, Mackenbach JP, Vineis P, Kivimäki M, Alenius H, Avendano M, Barros H, Bochud M, Carmeli C, Carra L, Castagné R, Chadeau-Hyam M, Clavel-Chapelon F, Costa G, Courtin E, Delpierre C, D’Errico A, Dugué P-A, Elliott P, Fraga S, Gares V, Giles G, Goldberg M, Greco D, Hodge A, Irving MK, Karisola P, Kivimäki M, Krogh V, Lang T, Layte R, Lepage B, Mackenbach J, Marmot M, McCrory C, Milne R, Muennig P, Nusselder W, Panico S, Petrovic D, Polidoro S, Preisig M, Raitakari O, Ribeiro AI, Ribeiro AI, Ricceri F, Robinson O, Valverde JR, Sacerdote C, Satolli R, Severi G, Shipley MJ, Stringhini S, Tumino R, Vineis P, Vollenweider P, Zins M. Socioeconomic status and the 25 × 25 risk factors as determinants of premature mortality: a multicohort study and meta-analysis of 1·7 million men and women. Lancet. 2017;389:1229–1237. - PMC - PubMed
    1. Lynch JW, Kaplan GA, Cohen RD, Tuomilehto J, Salonen JT. Do Cardiovascular Risk Factors Explain the Relation between Socioeconomic Status, Risk of All-Cause Mortality, Cardiovascular Mortality, and Acute Myocardial Infarction? Am J Epidemiol. 1996;144:934–942. - PubMed
    1. Winkleby MA, Jatulis DE, Frank E, Fortmann SP. Socioeconomic status and health: how education, income, and occupation contribute to risk factors for cardiovascular disease. Am J Public Health. 1992;82:816–820. - PMC - PubMed

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