Socioeconomic status12/29/2023 22 Gerber et al 22 found that each $10 000 increase in median income of a neighborhood reduced mortality risk in the group by 10%.Ī study of >15 000 patients admitted for acute myocardial infarction (AMI) or CHD in the Netherlands found that individuals in the lower quintiles of income had significantly higher rates of 28-day and 1-year mortality. 12 The results may be applicable at both an individual and neighborhood level. 11, 12 A large study in the United States and Finland found an increased risk of nonfatal myocardial infarction and sudden cardiac death in the low-income cohorts that persisted after adjusting for smoking and alcohol consumption. Income level has been consistently associated with CVD risk. We review the current state of knowledge on the impact of SES on the incidence, treatment, and outcomes of CVD in high-income societies and suggest future research directions aimed at the elimination of these adverse factors, and the integration of measures of SES into the customization of cardiovascular treatment, as well. 7 Better understanding of SES and risk stratification are critical first steps in identifying and tailoring interventions to improve CVD risk in the population. 6 Several interventions have been evaluated to improve health disparities attributable to social inequity, but results are inconsistent. 4, 5Įstablished interventions exist for addressing SES-related determinants of health and health inequities. 2, 3 The increased burden of CVD in people with low SES is attributable to a constellation of biological, behavioral, and psychosocial risk factors that are more prevalent in disadvantaged individuals. Low SES has been linked to the development of CVD and may confer a cardiovascular risk that is equivalent to traditional risk factors. 1 Traditional CVD risk factors have been identified, including hypertension, dyslipidemia, diabetes mellitus, family history of premature coronary heart disease (CHD), and smoking however, the contribution of social determinants of health, as best represented by socioeconomic status (SES), to CVD risk is poorly understood. CVD accounts for nearly 1 in 3 deaths in the United States despite a 25.3% decrease in age-standardized deaths attributed to CVD from 2004 to 2014. We review the current state of knowledge on the impact of SES on the incidence, treatment, and outcomes of CVD in high-income societies and suggest future research directions aimed at the elimination of these adverse factors, and the integration of measures of SES into the customization of cardiovascular treatment.Ĭardiovascular diseases (CVDs) remain the leading cause of death from chronic disease in the United States and worldwide despite remarkable advances made in the past century. Future research is required to better understand the underlying mechanisms of CVD risk that affect individuals of low SES and to determine effective interventions for patients with high risk. Integration of SES into the traditional CVD risk prediction models may allow improved management of individuals with high risk, but cultural and regional differences in SES make generalized implementation challenging. Task shifting, the redistribution of healthcare management from physician to nonphysician providers in an effort to improve access to health care, may have a role in select areas. Structured physical activity has demonstrated effectiveness in low-SES populations, and geomapping may be used to identify targets for large-scale programs. Promising approaches are emerging that can be implemented on an individual, community, or population basis to reduce disparities in outcomes. Interventions targeting patients with low SES have predominantly focused on modification of traditional CVD risk factors. In addition, disparities based on sex have been shown in several studies. Four measures have been consistently associated with CVD in high-income countries: income level, educational attainment, employment status, and neighborhood socioeconomic factors. Biological, behavioral, and psychosocial risk factors prevalent in disadvantaged individuals accentuate the link between SES and cardiovascular disease (CVD). Socioeconomic status (SES) has a measurable and significant effect on cardiovascular health. Customer Service and Ordering Information.Stroke: Vascular and Interventional Neurology.Journal of the American Heart Association (JAHA).Circ: Cardiovascular Quality & Outcomes.Arteriosclerosis, Thrombosis, and Vascular Biology (ATVB).
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