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Int J Angiol
DOI: 10.1055/a-2645-8778
DOI: 10.1055/a-2645-8778
Review Article
Social Determinants of Health and Effects on Cardiovascular Disease
Abstract
Research has shown that social determinants of health (SDOH) can influence health outcomes by up to 30 to 55% and can account for 80 to 90% of a person's health status. Our review evaluates SDOH in cardiovascular disease patients and assesses their impact in the field of cardiology as evidenced by research in the literature. Such SDOH as housing availability, access to healthy foods, access to transportation, access to medications, quality of living conditions, quality of schooling, and many other factors, have a great impact upon our patients' outcomes. Nowhere is this more true than in the field of cardiovascular disease, which is the leading cause of death worldwide. By recognizing SDOH and managing them through detection and prevention, patient outcomes can be affected in a positive direction. The key to being successful in this endeavor is to improve our patients' health literacy, promote prevention, and ameliorate the negative factors that affect health outcomes.
Keywords
social determinants of health - cardiovascular disease - cardiology - socioeconomic - health care access - economic status - communityPublication History
Article published online:
29 July 2025
© 2025. International College of Angiology. This article is published by Thieme.
Thieme Medical Publishers, Inc.
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References
- 1 Marmot M. Social determinants of health inequalities. Lancet 2005; 365 (9464) 1099-1104
- 2 Healthy People 2030. U.S. Department of Health and Human Services. Accessed March 9, 2024 at: https://health.gov/healthypeople/objectives-and-data/social-determinants-health
- 3 Roth GA, Mensah GA, Johnson CO. et al; GBD-NHLBI-JACC Global Burden of Cardiovascular Diseases Writing Group. Global burden of cardiovascular diseases and risk factors, 1990–2019. J Am Coll Cardiol 2020; 76 (25) 2982-3021
- 4 Teshale AB, Htun HL, Owen A. et al. The role of social determinants of health in cardiovascular diseases: an umbrella review. J Am Heart Assoc 2023; 12 (13) e029765
- 5 Powell-Wiley TM, Baumer Y, Baah FO. et al. Social determinants of cardiovascular disease. Circ Res 2022; 130 (05) 782-799
- 6 Flora GD, Nayak MK. A brief review of cardiovascular diseases, associated risk factors and current treatment regimes. Curr Pharm Des 2019; 25 (38) 4063-4084
- 7 Kreatsoulas C, Anand SS. The impact of social determinants on cardiovascular disease. Can J Cardiol 2010; 26 (Suppl C, Suppl C): 8C-13C
- 8 Havranek EP, Mujahid MS, Barr DA. et al; American Heart Association Council on Quality of Care and Outcomes Research, Council on Epidemiology and Prevention, Council on Cardiovascular and Stroke Nursing, Council on Lifestyle and Cardiometabolic Health, and Stroke Council. Social determinants of risk and outcomes for cardiovascular disease: a scientific statement from the American Heart Association. Circulation 2015; 132 (09) 873-898
- 9 Coke LA, Dennison Himmelfarb C. Guideline on the primary prevention of cardiovascular disease: Let's Get It Into Practice!. J Cardiovasc Nurs 2019; 34 (04) 285-288
- 10 USDA ERS - Food Environment Atlas. U.S. Department of Agriculture. Accessed March 17, 2024 at: https://www.ers.usda.gov/data-products/food-environment-atlas/
- 11 GBD 2017 Diet Collaborators. Health effects of dietary risks in 195 countries, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2019; 393 (10184): 1958-1972
- 12 Swinburn BA, Sacks G, Hall KD. et al. The global obesity pandemic: shaped by global drivers and local environments. Lancet 2011; 378 (9793) 804-814
- 13 Brandt EJ, Tobb K, Cambron JC. et al. Assessing and addressing social determinants of cardiovascular health: JACC State-of-the-Art Review. J Am Coll Cardiol 2023; 81 (14) 1368-1385
- 14 Bechthold A, Boeing H, Schwedhelm C. et al. Food groups and risk of coronary heart disease, stroke and heart failure: a systematic review and dose-response meta-analysis of prospective studies. Crit Rev Food Sci Nutr 2019; 59 (07) 1071-1090
- 15 Coe S, Spiro A. Cooking at home to retain nutritional quality and minimise nutrient losses: a focus on vegetables, potatoes and pulses. Nutr Bull 2022; 47 (04) 538-562
- 16 Gill V, Kumar V, Singh K, Kumar A, Kim JJ. Advanced glycation end products (AGEs) may be a striking link between modern diet and health. Biomolecules 2019; 9 (12) 888
- 17 U.S. Department of Agriculture, Agricultural Research Service. FoodData Central. Accessed May 13, 2025 at: https://fdc.nal.usda.gov
- 18 GBD 2019 Risk Factors Collaborators. Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2020; 396 (10258): 1223-1249
- 19 Ravera A, Carubelli V, Sciatti E. et al. Nutrition and cardiovascular disease: finding the perfect recipe for cardiovascular health. Nutrients 2016; 8 (06) 363
- 20 Jacobs DE. Environmental health disparities in housing. Am J Public Health 2011; 101 (Suppl 1, Suppl 1): S115-S122
- 21 Kondo MC, Fluehr JM, McKeon T, Branas CC. Urban green space and its impact on human health. Int J Environ Res Public Health 2018; 15 (03) 445
- 22 Chelak K, Chakole S. The role of social determinants of health in promoting health equality: a narrative review. Cureus 2023; 15 (01) e33425
- 23 Zhang K, Brook RD, Li Y, Rajagopalan S, Kim JB. Air pollution, built environment, and early cardiovascular disease. Circ Res 2023; 132 (12) 1707-1724
- 24 Diez Roux AV, Mujahid MS, Hirsch JA, Moore K, Moore LV. The impact of neighborhoods on cardiovascular risk. Glob Heart 2016; 11 (03) 353-363
- 25 Cai Y, Hodgson S, Blangiardo M. et al. Road traffic noise, air pollution and incident cardiovascular disease: a joint analysis of the HUNT, EPIC-Oxford and UK Biobank cohorts. Environ Int 2018; 114: 191-201
- 26 Giles-Corti B, Bull F, Knuiman M. et al. The influence of urban design on neighbourhood walking following residential relocation: longitudinal results from the RESIDE study. Soc Sci Med 2013; 77: 20-30
- 27 Moudon AV, Cook AJ, Ulmer J, Hurvitz PM, Drewnowski A. A neighborhood wealth metric for use in health studies. Am J Prev Med 2011; 41 (01) 88-97
- 28 Auchincloss AH, Diez Roux AV, Mujahid MS, Shen M, Bertoni AG, Carnethon MR. Neighborhood resources for physical activity and healthy foods and incidence of type 2 diabetes mellitus: the Multi-Ethnic study of Atherosclerosis. Arch Intern Med 2009; 169 (18) 1698-1704
- 29 Gebel K, Bauman A, Owen N. Correlates of non-concordance between perceived and objective measures of walkability. Ann Behav Med 2009; 37 (02) 228-238
- 30 Lovasi GS, Schwartz-Soicher O, Quinn JW. et al. Neighborhood safety and green space as predictors of obesity among preschool children from low-income families in New York City. Prev Med 2013; 57 (03) 189-193
- 31 Liao Y, Bang D, Cosgrove S. et al; Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC). Surveillance of health status in minority communities—Racial and Ethnic Approaches to Community Health Across the U.S. (REACH U.S.) risk factor survey, United States, 2009. MMWR Surveill Summ 2011; 60 (06) 1-44
- 32 Weeks WB, Chang JE, Pagán JA. et al. Rural-urban disparities in health outcomes, clinical care, health behaviors, and social determinants of health and an action-oriented, dynamic tool for visualizing them. PLOS Glob Public Health 2023; 3 (10) e0002420
- 33 Son H, Zhang D, Shen Y. et al. Social determinants of cardiovascular health: a longitudinal analysis of cardiovascular disease mortality in US counties from 2009 to 2018. J Am Heart Assoc 2023; 12 (02) e026940
- 34 Centers for Disease Control and Prevention. Social determinants of health. Published 2022 . Accessed January 2025 at: https://www.cdc.gov/socialdeterminants/index.htm
- 35 Adler NE, Stewart J. Health disparities across the lifespan: meaning, methods, and mechanisms. Ann N Y Acad Sci 2010; 1186 (01) 5-23
- 36 Cohen S, Janicki-Deverts D, Miller GE. Psychological stress and disease. JAMA 2007; 298 (14) 1685-1687
- 37 Chetty R, Stepner M, Abraham S. et al. The association between income and life expectancy in the United States, 2001–2014. JAMA 2016; 315 (16) 1750-1766
- 38 Schultz WM, Kelli HM, Lisko JC. et al. Socioeconomic status and cardiovascular outcomes: challenges and interventions. Circulation 2018; 137 (20) 2166-2178
- 39 Benedict CR, Shelton B, Johnstone DE. et al; SOLVD Investigators. Prognostic significance of plasma norepinephrine in patients with asymptomatic left ventricular dysfunction. Circulation 1996; 94 (04) 690-697
- 40 Lundberg U. Stress hormones in health and illness: the roles of work and gender. Psychoneuroendocrinology 2005; 30 (10) 1017-1021
- 41 Elwell-Sutton T, Fok J, Albanese F, Mathie H, Holland R. Factors associated with access to care and healthcare utilization in the homeless population of England. J Public Health (Oxf) 2017; 39 (01) 26-33
- 42 Stafford A, Wood L. Tackling health disparities for people who are homeless? Start with social determinants. Int J Environ Res Public Health 2017; 14 (12) 1535
- 43 Havranek EP. The influence of social and economic factors on heart disease. JAMA Cardiol 2019; 4 (12) 1212-1213
- 44 Zajacova A, Lawrence EM. The relationship between education and health: reducing disparities through a contextual approach. Annu Rev Public Health 2018; 39: 273-289
- 45 Gozdzik A, Salehi R, O'Campo P, Stergiopoulos V, Hwang SW. Cardiovascular risk factors and 30-year cardiovascular risk in homeless adults with mental illness. BMC Public Health 2015; 15: 165
- 46 Baggett TP, Liauw SS, Hwang SW. Cardiovascular disease and homelessness. J Am Coll Cardiol 2018; 71 (22) 2585-2597
- 47 Seligman HK, Schillinger D. Hunger and socioeconomic disparities in chronic disease. N Engl J Med 2010; 363 (01) 6-9
- 48 Leung CW, Epel ES, Ritchie LD, Crawford PB, Laraia BA. Food insecurity is inversely associated with diet quality of lower-income adults. J Acad Nutr Diet 2014; 114 (12) 1943-53.e2
- 49 Iqbal R, Dehghan M, Mente A. et al. Associations of unprocessed and processed meat intake with mortality and cardiovascular disease in 21 countries [Prospective Urban Rural Epidemiology (PURE) Study]: a prospective cohort study. Am J Clin Nutr 2021; 114 (03) 1049-1058
- 50 Pacheco LS, Lacey Jr JV, Martínez ME. et al. Sugar-sweetened beverage intake and cardiovascular disease risk in the California Teachers Study. J Am Heart Assoc 2020; 9 (10) e014883
- 51 Ogden CL, Fakhouri TH, Carroll MD. et al. Prevalence of obesity among adults, by household income and education—United States, 2011–2014. MMWR Morb Mortal Wkly Rep 2017; 66 (50) 1369-1373
- 52 Telfair J, Shelton TL. Educational attainment as a social determinant of health. N C Med J 2012; 73 (05) 358-365
- 53 Adler NE, Newman K. Socioeconomic disparities in health: pathways and policies. Health Aff (Millwood) 2002; 21 (02) 60-76
- 54 Cutler D, Lleras-Muney A. Education and health: National Poverty Center policy brief #9. Ann Arbor, MI: National Poverty Center; 2007
- 55 Magnani JW, Ning H, Wilkins JT, Lloyd-Jones DM, Allen NB. Educational attainment and lifetime risk of cardiovascular disease. JAMA Cardiol 2023; 8 (03) 3990
- 56 Donovan NJ, Blazer D. Social isolation and loneliness in older adults: review and commentary of a National Academies report. Am J Geriatr Psychiatry 2020; 28 (12) 1233-1244
- 57 Paul E, Bu F, Fancourt D. Loneliness and risk for cardiovascular disease: mechanisms and future directions. Curr Cardiol Rep 2021; 23 (06) 68
- 58 Singh R, Javed Z, Yahya T. et al. Community and social context: an important social determinant of cardiovascular disease. Methodist DeBakey Cardiovasc J 2021; 17 (04) 15-27
- 59 Özbay F, Johnson DC, Dimoulas E, Morgan CA, Charney D, Southwick S. Social support and resilience to stress: from neurobiology to clinical practice. Psychiatry (Edgmont) 2007; 4 (05) 35-40
- 60 Godoy LC, Frankfurter C, Cooper M, Lay C, Maunder R, Farkouh ME. Association of adverse childhood experiences with cardiovascular disease later in life: a review. JAMA Cardiol 2021; 6 (02) 228-235
- 61 Liu N, Liu S, Yu N. et al. Correlations among psychological resilience, self-efficacy, and negative emotion in acute myocardial infarction patients after percutaneous coronary intervention. Front Psychiatry 2018; 9: 1
- 62 Sutin AR, Boutelle K, Czajkowski SM. et al. Accumulating data to optimally predict obesity treatment (ADOPT) core measures: psychosocial domain. Obesity (Silver Spring) 2018; 26 (Suppl 2, Suppl 2): S45-S54
- 63 Song L, Wang Y, Chen B, Yang T, Zhang W, Wang Y. The association between health insurance and all-cause, cardiovascular disease, cancer and cause-specific mortality: a prospective cohort study. Int J Environ Res Public Health 2020; 17 (05) 1525
- 64 Ganguli I, Shi Z, Orav EJ, Rao A, Ray KN, Mehrotra A. Declining use of primary care among commercially insured adults in the United States, 2008–2016. Ann Intern Med 2020; 172 (04) 240-247
- 65 de Andrade LO, Pellegrini Filho A, Solar O. et al. Social determinants of health, universal health coverage, and sustainable development: case studies from Latin American countries. Lancet 2015; 385 (9975) 1343-1351
- 66 Donkin A, Goldblatt P, Allen J, Nathanson V, Marmot M. Global action on the social determinants of health. BMJ Glob Health 2017; 3 (1, Suppl 1): e000603
- 67 Tessema ZT, Worku MG, Tesema GA. et al. Determinants of accessing healthcare in Sub-Saharan Africa: a mixed-effect analysis of recent demographic and health surveys from 36 countries. BMJ Open 2022; 12 (01) e054397
- 68 Whitman A, De Lew N, Chappel A, Aysola V, Zuckerman R, Sommers BD. Addressing social determinants of health: examples of successful evidence-based strategies and current federal efforts. Assistant Secretary for Planning and Evaluation, Office of Health Policy, U.S. Department of Health and Human Services; April 1, 2022. Report No. HP-2022-12.
- 69 KPMG Government Institute. Investing in social services as a core strategy for healthcare organizations: developing the business case. 2018 . Accessed May 27, 2025 at: https://institutes.kpmg.us/content/dam/institutes/en/government/pdfs/2018/investing-socialservices.pdf
- 70 Hess A, Passaretti M, Coolbaugh S. Fresh food farmacy. Am J Health Promot 2019; 33 (05) 830-832
- 71 Gurvey J, Rand K, Daugherty S, Dinger C, Schmeling J, Laverty N. Examining health care costs among MANNA clients and a comparison group. J Prim Care Community Health 2013; 4 (04) 311-317
- 72 Berkowitz SA, Terranova J, Hill C. et al. Meal delivery programs reduce the use of costly health care in dually eligible Medicare and Medicaid beneficiaries. Health Aff (Millwood) 2018; 37 (04) 535-542
- 73 Sadowski LS, Kee RA, VanderWeele TJ, Buchanan D. Effect of a housing and case management program on emergency department visits and hospitalizations among chronically ill homeless adults: a randomized trial. JAMA 2009; 301 (17) 1771-1778
- 74 Kersten EE, LeWinn KZ, Gottlieb L, Jutte DP, Adler NE. San Francisco children living in redeveloped public housing used acute services less than children in older public housing. Health Aff (Millwood) 2014; 33 (12) 2230-2237
- 75 Williams SG, Brown CM, Falter KH. et al. Does a multifaceted environmental intervention alter the impact of asthma on inner-city children?. [published correction appears in J Natl Med Assoc. 2009;101(2):99] J Natl Med Assoc 2006; 98 (02) 249-260
- 76 King BA, Peck RM, Babb SD. Cost savings associated with prohibiting smoking in U.S. subsidized housing. Am J Prev Med 2013; 44 (06) 631-634
- 77 Olshansky SJ, Antonucci T, Berkman L. et al. Differences in life expectancy due to race and educational differences are widening, and many may not catch up. Health Aff (Millwood) 2012; 31 (08) 1803-1813
- 78 West S, Castro Baker A, Samra S. , et al. Preliminary analysis: SEED's First Year; 2021 . Accessed May 29, 2025 at: https://static1.squarespace.com/static/6039d612b17d055cac14070f/t/603ef1194c474b329f33c329/1614737690661/SEED_Preliminary+Analysis-SEEDs+First+Year_Final+Report_Individual+Pages+-2
- 79 Arno PS, Sohler N, Viola D, Schechter C. Bringing health and social policy together: the case of the earned income tax credit. J Public Health Policy 2009; 30 (02) 198-207
- 80 Hoynes H, Miller D, Simon D. Income, the earned income tax credit, and infant health. Am Econ J Econ Policy 2015; 7 (01) 172-211
- 81 Herd P, Schoeni RF, House JS. Upstream solutions: does the supplemental security income program reduce disability in the elderly?. University of Wisconsin Madison; University of Michigan, Ann Arbor. Accessed May 29, 2025 at: https://deepblue.lib.umich.edu/bitstream/handle/2027.42/72843/j.1468-0009.2007.00512.x.pdf
- 82 Centers for Disease Control and Prevention. Early Childhood Education. Accessed May 30, 2025 at: https://www.cdc.gov/policy/hst/hi5/earlychildhoodeducation/index.html
- 83 Morrissey T. The effects of early care and education on children's health. Health Aff (Millwood). April 2019. Accessed May 30, 2025 at: https://www.healthaffairs.org/do/10.1377/hpb20190325.519221/full/
- 84 Magnani JW, Mujahid MS, Aronow HD. et al; American Heart Association Council on Epidemiology and Prevention; Council on Cardiovascular Disease in the Young; Council on Cardiovascular and Stroke Nursing; Council on Peripheral Vascular Disease; Council on Quality of Care and Outcomes Research; and Stroke Council. Health literacy and cardiovascular disease: fundamental relevance to primary and secondary prevention: a scientific statement from the American Heart Association. Circulation 2018; 138 (02) e48-e74