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Intersectionality and Social Drivers of Health in Cardiovascular Care Cover

Intersectionality and Social Drivers of Health in Cardiovascular Care

Methodist DeBakey Cardiovascular Journal
Volume 20 (2024): Issue 5
By: ,  ,   and    
Open Access
|Nov 2024
Figures & tables

Figures & Tables

Figure 1

Multiple social drivers of health intersect to impact cardiovascular health.

Table 1

Selected studies on associations between social drivers and cardiovascular outcomes. OR: odds ratio; HR: hazard ratio; CV: cardiovascular; CVD: cardiovascular disease; CAD: coronary artery disease; CHD: coronary heart disease; MI: myocardial infarction

STUDYSTUDY DESIGNSTUDY SIZESOCIAL DRIVER AND OUTCOME (95% CI)
Socioeconomic Status
Yan et al. 200610Prospective cohort2913 individualsLess than high school versus beyond college education; coronary artery calcium adjusted OR

  • – 14 (2.33-7.35), adjusted for age, race, and sex

  • – 61 (1.40-4.85) adjusted for blood pressure, cholesterol, smoking, exercise, and waist circumference

Khaing et al. 201711Meta-analysis72 studiesLow versus high education, pooled risk ratios

  • – CAD: 1.36 (1.11-1.66)

  • – CV events: 1.50 (1.17-1.92)

  • – Stroke: 1.23 (1.06-1.40)

  • – CV death: 1.39 (1.26-1.54)

Low versus high income, pooled risk ratios

  • – CAD: 1.49 (1.16-1.91)

  • – CV events: 1.17 (0.96-1.44)

  • – Stroke: 1.30 (0.99-1.72)

  • – CV death: 1.76 (1.45-2.14)

Machado et al. 202112Retrospective cohort5579 individualsFinancial mobility; CV event or CV death adjusted HR

  • – Upward: 0.84 (0.73-0.97)

  • – Downward: 1.15 (1.00-1.32)

Johnson et al. 202214Cross-sectional7771 individualsHigh school graduates versus less than high school education; ideal CV health by Life’s Simple 7 adjusted OR

  • – Non-Hispanic White individuals: 1.46 (1.06-2.02)

  • – Non-Hispanic Black individuals: 0.99 (0.69-1.43)

Psychosocial
Valtorta et al. 201616Meta-analysis11 CHD; 9 stroke studiesPoor social relationships, pooled relative risk

  • – Incident CHD: 1.29 (1.04-1.59)

  • – Stroke: 1.32 (1.04-1.68)

Stewart et al. 201719Prospective cohort950 individualsChronic moderate/high psychological stress in patients with CAD, adjusted HR

  • – CV death: 3.94 (2.05-7.56)

  • – All-cause mortality: 2.85 (1.74-4.66)

Richardson et al. 201218Meta-analysis6 studiesHigh perceived stress, aggregate risk ratio CHD development 1.27 (1.12-1.45)
Kwapong et al. 202320Cross-sectional593,616 individualsDepression, OR

  • – CVD: 2.32 (2.13-2.51)

  • – Suboptimal CV health (at least two CVD risk factors): 1.79 (1.65-1.95)

Environment
Klompmaker et al. 202227Retrospective cohort63 million individualsIncreased neighborhood vegetation, HR

  • – CVD hospitalization: 0.97 (0.96-0.97)

  • – Respiratory disease hospitalization: 0.99 (0.98-1.00)

Kelli et al. 201929Prospective cohort4,944 individualsResidence, sub-distribution HR for MI

  • – In food desert (low-income, low food access): 1.44 (1.06-1.95)

  • – Low food access area: 1.05 (0.80-1.38)

  • – Low-income area: 1.40 (1.06-1.85)

Kershaw et al. 201533Prospective cohort5,229 individualsNeighborhood with racial/ethnic segregation; adjusted HR for incident CVD

  • – Black individuals: 1.12 (1.02-1.22)

  • – White individuals: 0.88 (0.81-0.96)

Deo et al. 202334Retrospective cohort79,997 individualsNeighborhoods with history of redlining; HR

  • – Major adverse cardiac event: 1.14 (1.08-1.2)

  • – MI: 1.15 (1.01-1.30)

  • – All-cause mortality: 1.13 (1.07-1.19)

  • – Stroke: 0.89 (0.58-1.35)

Al-Shakarchi et al. 202028Meta-analysis9 studiesIndividuals undergoing homelessness

  • – Pooled OR for CVD: 2.96 (2.80-3.13)

  • – Pooled OR for hypertension: 1.38-1.75

  • – CVD mortality: age standardized mortality ratio range: 2.6-6.4

Discrimination and Marginalization
Hines et al. 202317Cross-sectional7,720 individualsBlack versus White individuals, high ideal CV health score pooled OR

  • – All genders: 0.53 (0.45-0.61)

  • – Women: 0.45 (0.37-0.54)

  • – Men: 0.73 (0.57-0.93)

Burroughs Peña et al. 202139Cross-sectional25,062 individualsHigh versus low ideal CV health score adjusted OR

  • – Black versus White women: 0.46 (0.28-0.75)

  • – Asian versus White women: 2.21 (1.65-2.98)

Hailu et al. 202037Cross-sectional1,153 individualsIndividuals with low social support, decrease in leukocyte telomere length

  • – Moderate reported everyday discrimination: 0.35 (0.54-0.16)

  • – High reported everyday discrimination: 0.17 (0.34-0.01)

Table 2

Framework and recommendations for social drivers of health (SDOH) interventions.

LEVEL OF INTERVENTIONRECOMMENDATIONS FOR ACTION
Clinician and Health SystemImplement standardized SDOH screening tool in electronic medical record
Develop community-specific resource lists to address SDOH
Utilize community health workers or social workers on staff for care and services coordination
Partner with local community
Increase workforce diversity and inclusion
CommunityImplement community health worker, trained peer advisor, nurse-lead health programs
Develop programs regarding housing, food, transportation, employment access
Partner with local health systems
ResearchUse community-led research methodology
Consider intersectionality in research design and prioritize recruiting large and diverse populations for studies
Develop risk-prediction tools incorporating SDOH
Critically analyze use of race in studies
Test interventions at small scale before policy change
State and FederalIncrease insurance access
Develop programs for care coordination and access to social support services
Implement public health campaigns regarding health behaviors
Increase funding for community and health system programs
Consolidate and report results of various initiatives attempted
DOI: https://doi.org/10.14797/mdcvj.1436 | Journal eISSN: 1947-6108
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Language: English
Page range: 98 - 110
Submitted on: Jun 19, 2024
Accepted on: Aug 22, 2024
Published on: Nov 5, 2024
Published by: Houston Methodist DeBakey Heart & Vascular Center
In partnership with: Paradigm Publishing Services
Keywords:
social drivers of health,
socioeconomic status,
stress,
discrimination,
cardiovascular health,
intersectionality

© 2024 Madelyn Hurwitz, Jason Bonomo, Jared Spitz, Garima Sharma, published by Houston Methodist DeBakey Heart & Vascular Center
This work is licensed under the Creative Commons Attribution-NonCommercial 4.0 License.

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