CVD Risk Faces Undue Influence From Social Determinants of Health

Social determinants found within a person’s environment, mainly where they live and work, have been shown to influence outcomes related to health, functioning, and quality of life, especially where risk of cardiovascular disease (CVD) is concerned, according to study results released today that will be presented during ACC.20/WCC Virtual, this year’s American College of Cardiology (ACC) Annual Scientific Session jointly held with the World Congress of Cardiology on March 28-30. The live meeting was canceled earlier this month due to the coronavirus pandemic.

“Impact of Social Determinants of Health on Cardiovascular Diseases” comes from a team of investigators out of George Mason University (GMU) led by lead author Tarang Parekh, MBBS, Department of Health Administration and Policy at GMU and lead study author.

“We are very focused on addressing certain cardiovascular risk factors, but we forget about factors such as food, housing, and financial security that often play a major role in the development of cardiovascular disease,” Parekh stated. “We are not investing enough to address these issues. We [must] start addressing patients’ problems from a broader perspective in order to better reduce the toll of cardiovascular diseases.”

Using 2017 data on more than 400,000 US adults from the CDC’s Behavioral Risk Factor Surveillance System, Parekh and colleagues evaluated how social determinants of health (SDOH) affected “their likelihood of having various forms of heart disease.” The team focused on the wider impact these SDOH have—especially food insecurity, financial stability, and healthcare access—on CVDs as a whole. There is already an abundance of research focused on individual-level risk factors, they said, that influence CVD.

Also important is that, “Understanding the relationship between how population groups experience ‘place’ and the impact of ‘place’ on health is fundamental to the social determinants of health—including both social and physical determinants,” according to the Office of Disease Prevention and Health Promotion.

Among the respondents, close to 1 in 10 had at least 1 form of heart disease. The 3 main SDOH shown to impact this risk were food (adjusted odds ratio [AOR], 1.51; 95% CI, 1.28-1.77) and housing (AOR, 1.54; 95% CI, 1.28-1.85) insecurity (>50% greater risk), healthcare access hardship (AOR, 1.47; 95% CI, 1.34-1.61; 47% greater risk), and high degree of financial insecurity (AOR, 2.14; 95% CI, 1.73-2.66; twice as likely) (see Table).

Broken down, compared with respondents who did not have CVD, SDOHs occurred at much higher rates in respondents who had CVD:

• Food insecurity: 27.5% versus 21.2%
• Housing insecurity: 14.5% versus 8.78%
• Financial insecurity: 18.2% versus 8.32%

How exactly do the above increase the risk of having HD? According to the study results, food insecurity could mean individuals don’t have the ability to eat a heart-healthy diet because they can’t afford to buy those foods; housing and financial insecurity can compound stress, and that can trigger heart disease; and not being able to access adequate healthcare services could mean treatment delays and more advanced disease progression at diagnosis.

Thankfully, health systems and physicians are increasingly recognizing the influence SDOH have on their patients’ heart health and are instituting measures to break down some of the barriers they create. For example, by connecting them to resources in their communities, including SDOH questions in patients’ electronic health records, and asking about any potential issues during visits.

“We plan to further investigate the timing of heart disease development to shed more light on its relationship with social and financial factors,” the GMU team said.

Reference

Parekh T, Desai R, Pemmasani S, Cuellar A. Understanding the impact of social determinants of health on cardiovascular diseases. To be presented at: ACC.20/WCC Virtual; March 28-30, 2020; accscientificsession.acc.org/.