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. 2023 Jul 4;12(13):e029765.
doi: 10.1161/JAHA.123.029765. Epub 2023 Jun 22.

The Role of Social Determinants of Health in Cardiovascular Diseases: An Umbrella Review

Achamyeleh Birhanu Teshale  1 , Htet Lin Htun  1 , Alice Owen  1 , Danijela Gasevic  1 , Aung Zaw Zaw Phyo  1 , Daisy Fancourt  2 , Joanne Ryan  1 , Andrew Steptoe  2 , Rosanne Freak-Poli  1   3
Affiliations

The Role of Social Determinants of Health in Cardiovascular Diseases: An Umbrella Review

Achamyeleh Birhanu Teshale et al. J Am Heart Assoc. .

Abstract

Cardiovascular disease (CVD) is the leading cause of mortality worldwide. Addressing social determinants of health (SDoH) may be the next forefront of reducing the enormous burden of CVD. SDoH can be defined as any social, economic, or environmental factor that influences a health outcome. Comprehensive evidence of the role of SDoH in CVD is lacking, nevertheless. This umbrella review aims to give a comprehensive overview of the role of SDoH in CVD. We searched systematic reviews (with or without meta-analyses) using 8 databases and included review reference lists. Four themes (economic circumstances, social/community context, early childhood development, and neighbourhood/built environment) and health literacy in the health/health care theme were considered. Seventy reviews were eligible. Despite the quality of the included reviews being low or critically low, there was consistent evidence that factors relating to economic circumstances and early childhood development themes were associated with an increased risk of CVD and CVD mortality. We also found evidence that factors in the social/community context and neighbourhood/built environment themes, such as social isolation, fewer social roles, loneliness, discrimination, ethnicity, neighborhood socioeconomic status, violence, and environmental attributes, had a role in CVD. SDoH factors without (or with minimal) evidence synthesis for CVD were also identified. In sum, this umbrella review offers evidence that SDoH, especially economic circumstance and early childhood development, play a significant role in CVD. This calls for the strengthening of nonmedical interventions that address multiple factors simultaneously and the inclusion of SDoH in future CVD risk prediction models. Registration URL: https://www.crd.york.ac.uk/prospero/; Unique identifier: CRD42022346994.

Keywords: social context cardiovascular disease; social determinants of health; socioeconomic status; umbrella review.

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Figures

Figure 1
Figure 1. Conceptual framework indicating the domains of the social determinants of health and their association with cardiovascular disease.
Adapted from Healthy People 2020 and 2030 frameworks.,
Figure 2
Figure 2. Flow diagram for selection of studies adapted from the Preferred Reporting Items for Overviews of Reviews flow diagram.
CDSR indicates Cochrane Database of Systematic Reviews; and JBI, Joanna Briggs Institute.
Figure 3
Figure 3. Graphical presentation of the identified reviews per themes/domains of social determinants of health.
See this image and copyright information in PMC

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