The impact of social determinants on cardiovascular disease

Abstract

Cardiovascular disease is the leading cause of death among high-income countries and is projected to be the leading cause of death worldwide by 2030. Much of the current research efforts have been aimed toward the identification, modification and treatment of individual-level risk factors. Despite significant advancements, gross inequalities continue to persist over space and time. Although increasing at different rates worldwide, the magnitude of increase in the prevalence of various cardiovascular risk factors has shifted research efforts to study the causes of the risk factors (ie, the 'causes of the causes'), which include the social determinants of health. The social determinants of health reflect the impact of the social environment on health among people sharing a particular community. Imbalances in the social determinants of health have been attributed to the inequities in health observed between and within countries. The present article reviews the role of the social determinants of health on a global level, describing the epidemiological transition and the persistent trend known as the 'inverse social gradient'. The impact of social determinants in Canada will also be examined, including data from ethnic and Aboriginal communities. Possible solutions and future directions to reduce the impact of social factors on cardiovascular health are proposed.

Figures

Figure 1)

The epidemiological transition states of cardiovascular disease (CVD). CHD Coronary heart disease. Reproduced with permission from reference

Figure 2)

Socioeconomic influences on cardiovascular disease (CVD) from a lifecourse perspective. Reproduced with permission from reference

Figure 3)

Canadian poverty rates over time, 1984 to 2004. Reproduced with permission from reference

Figure 4)

Socioeconomic gradient and cardiovascular disease (CVD) among Aboriginal Peoples and European descendants in Canada. Reproduced with permission from reference

Figure 5)

Cardiovascular disease (CVD) risk factor prevalence and income among Aboriginal Peoples and European descendants in Canada. Reproduced with permission from reference

Figure 6)

Risk of cardiovascular disease and social disadvantage. Reproduced with permission from reference