The social determinants of ideal cardiovascular health: A global systematic review

Abstract

This systematic review synthesizes research published from January 2010-July 2022 on the social determinants of ideal cardiovascular health (CVH) carried out around the world and compares trends in high-income countries (HICs) to those in low- and middle-income countries (LMICs). 41 studies met inclusion criteria (n = 28 HICs, n = 13 LMICs). Most were from the United States (n = 22) and cross-sectional (n = 33), and nearly all evaluated associations among adults. Among studies conducted in LMICs, nearly all were from middle-income countries and only one was carried out in low-income country. Education (n = 24) and income/wealth (n = 17) were the most frequently examined social determinants in both HICs and LMICs. Although most studies assessed ideal CVH using reliable and valid methods (n = 24), only 7 used criteria pre-defined by the American Heart Association to characterize ideal levels of each CVH metric. Despite heterogeneity in how outcome measures were derived and analyzed, consistent associations were evident between multiple markers of higher social status (i.e. greater education, income/wealth, socioeconomic status, racial/ethnic majority status) and greater levels of ideal CVH across both country contexts. Gaps in the literature include evidence from LMICs and HICs other than the United States, longitudinal research, and investigations of a wider array of social determinants beyond education and income/wealth.

Keywords: Education; Employment; Ideal cardiovascular health; Income/wealth; Occupation; Race and ethnicity; Social determinants of health; Socioeconomic status; Systematic review.

Fig. 1.

Global map of high-income and low- and middle-income countries, based on classifications by The World Bank [31].

Fig. 2.

Screening process to identify studies for inclusion.

Fig. 3.

Summary of direction of association reported in studies examining associations between ideal cardiovascular health and (A) education (N = 24), (B) income/wealth (N = 17), (C) occupation (N = 10), (D) socioeconomic status (N = 8), and (E) race/ethnicity (N = 15).*.