Impact of Social Determinants of Health on Hypertension Outcomes: A Systematic Review

Abstract

Despite ample evidence linking social determinants of health (SDoH) and hypertension outcomes, efforts to address SDoH in the context of hypertension prevention and self-management are not commensurate with the burden and impact of hypertension. To provide valuable insights into the development of targeted and effective strategies for preventing and managing hypertension, this systematic review, guided by the Healthy People 2030 SDoH framework, aims to summarize the inclusion, measurement, and evaluation of SDoH in studies examining hypertension outcomes, with a focus on characterizing SDoH constructs and summarizing the current evidence of their influence on hypertension outcomes. Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, a comprehensive search of electronic databases identified 10 608 unique records, from which 57 articles meeting inclusion criteria were analyzed. The studies, conducted nationally or regionally across the United States, revealed that higher educational attainment, health insurance coverage, income, and favorable neighborhood characteristics were associated with lower hypertension prevalence and better hypertension control among US adults. The findings underscore the importance of addressing SDoH such as education, health care access, economic stability, neighborhood environments, and social context to reduce hypertension disparities. Multilevel collaboration and community-engaged practices are necessary to tackle these disparities effectively.

Keywords: United States; health equity; hypertension; social determinants of health; systematic review.

Figure 1:

PRISMA flow diagram illustrating the selection process of studies. The initial search identified 10,608 unique records. After removing 4,780 duplicates, 5,828 records remained for title and abstract screening. From these, 285 records were selected for full-text review. Upon assessing the full texts, 228 articles were excluded. Ultimately, 57 articles met the criteria for inclusion in the study.

Figure 2:

Heterogeneity in the measurement of Social Determinants of Health (SDoH) factors across various domains. Evidence linked higher educational attainment, insurance status, income level, and favorable neighborhood characteristics to better BP control and lower HTN prevalence among US adults.