Assessing and Addressing Social Determinants of Cardiovascular Health: JACC State-of-the-Art Review

Eric J Brandt; Kardie Tobb; Julia C Cambron; Keith Ferdinand; Paul Douglass; Patricia K Nguyen; Krishnaswami Vijayaraghavan; Sabrina Islam; Ritu Thamman; Shahid Rahman; Akshay Pendyal; Nishtha Sareen; Celina Yong; Latha Palaniappan; Uzoma Ibebuogu; Andrew Tran; Adrian M Bacong; Gina Lundberg; Karol Watson

doi:10.1016/j.jacc.2023.01.042

Assessing and Addressing Social Determinants of Cardiovascular Health: JACC State-of-the-Art Review

J Am Coll Cardiol. 2023 Apr 11;81(14):1368-1385. doi: 10.1016/j.jacc.2023.01.042.

Authors

Eric J Brandt¹, Kardie Tobb², Julia C Cambron³, Keith Ferdinand⁴, Paul Douglass⁵, Patricia K Nguyen⁶, Krishnaswami Vijayaraghavan⁷, Sabrina Islam⁸, Ritu Thamman⁹, Shahid Rahman¹⁰, Akshay Pendyal¹¹, Nishtha Sareen¹², Celina Yong⁶, Latha Palaniappan¹³, Uzoma Ibebuogu¹⁴, Andrew Tran¹⁵, Adrian M Bacong¹³, Gina Lundberg¹⁶, Karol Watson¹⁷

Affiliations

¹ Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA; Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA. Electronic address: [email protected].
² Cone Health Medical Group, Greensboro, North Carolina, USA.
³ Oregon Health and Science University, Portland, Oregon, USA.
⁴ Tulane University School of Medicine, New Orleans, Louisiana, USA.
⁵ Wellstar Health System Center for Cardiovascular Care, Marietta, Georgia, USA.
⁶ Stanford University School of Medicine, Department of Medicine, Division of Cardiovascular Medicine, Stanford, California, USA; VA Palo Alto Healthcare System, Palo Alto, California, USA.
⁷ The University of Arizona Medical Center, Tucson, Arizona, USA.
⁸ Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA.
⁹ University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania, USA.
¹⁰ Memorial Hermann Heart and Vascular Institute, Houston, Texas, USA.
¹¹ University of North Carolina School of Medicine, Novant Health Charlotte Campus, Charlotte, North Carolina, USA.
¹² Ascension Medical Group, Ascension St Mary's Hospital, Saginaw, Michigan, USA.
¹³ Stanford University School of Medicine, Department of Medicine, Division of Cardiovascular Medicine, Stanford, California, USA.
¹⁴ Division of Cardiovascular Diseases, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
¹⁵ The Heart Center, Nationwide Children's Hospital, Columbus, Ohio, USA; Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA.
¹⁶ Emory Women's Heart Center, Emory Heart and Vascular Center, Marietta, Georgia, USA.
¹⁷ Division of Cardiology, University of California, Los Angeles, California, USA.

Abstract

Social determinants of health (SDOH) are the social conditions in which people are born, live, and work. SDOH offers a more inclusive view of how environment, geographic location, neighborhoods, access to health care, nutrition, socioeconomics, and so on are critical in cardiovascular morbidity and mortality. SDOH will continue to increase in relevance and integration of patient management, thus, applying the information herein to clinical and health systems will become increasingly commonplace. This state-of-the-art review covers the 5 domains of SDOH, including economic stability, education, health care access and quality, social and community context, and neighborhood and built environment. Recognizing and addressing SDOH is an important step toward achieving equity in cardiovascular care. We discuss each SDOH within the context of cardiovascular disease, how they can be assessed by clinicians and within health care systems, and key strategies for clinicians and health care systems to address these SDOH. Summaries of these tools and key strategies are provided.

Keywords: built environment; community; economic stability; education; health care access; social environment.

Publication types

Review

MeSH terms

Health Services Accessibility*
Humans
Residence Characteristics
Social Determinants of Health*
Socioeconomic Factors

Grants and funding

K23 MD017253/MD/NIMHD NIH HHS/United States