The importance of socio-economic determinants of health in the care of patients with peripheral artery disease: A narrative review from VAS

Abstract

Socio-economic determinants of health (SDoH) include various nonmedical factors in the socio-economic sphere with a potentially significant impact on health outcomes. Their effects manifest through several mediators/moderators (behavioral characteristics, physical environment, psychosocial circumstances, access to care, and biological factors). Various critical covariates (age, gender/sex, race/ethnicity, culture/acculturation, and disability status) also interact. Analyzing the effects of these factors is challenging due to their enormous complexity. Although the significance of SDoH for cardiovascular diseases is well documented, research regarding their impact on peripheral artery disease (PAD) occurrence and care is less well documented. This narrative review explores to what extent SDoH are multifaceted in PAD and how they are associated with its occurrence and care. Additionally, methodological issues that may hamper this effort are addressed. Finally, the most important question, whether this association may contribute to reasonable interventions aimed at SDoH, is analyzed. This endeavor requires attention to the social context, a whole systems approach, multilevel-thinking, and a broader alliance that reaches out to more stakeholders outside the medical sphere. More research is needed to justify the power in this concept to improve PAD-related outcomes like lower extremity amputations. At the present time, some evidence, reasonable consideration, and intuitive reasoning support the implementation of various interventions in SDoH in this field.

Keywords: life-course epidemiology; peripheral artery disease (PAD); socio-economic determinants of health (SDoH).

Figure 1.

The conceptual framework of socio-economic determinants of health, mediators/moderators, and the critical covariates.^–

Figure 2.

Various mediators/moderators of socio-economic determinants of health, through which their impacts are manifested.^,,

Figure 3.

Illustration of the potentials of interventions on socio-economic determinants of health. Interventions on socio-economic determinants of health may shift the characteristic curve that indicates the relationship between the risk of adverse outcomes with peripheral artery disease (PAD) and the degree of socio-economic disadvantage, down to the left.