McMaster University, Hamilton, Ontario, Canada.
Can J Cardiol. 2010 Aug-Sep;26 Suppl C(Suppl C):8C-13C. doi: 10.1016/s0828-282x(10)71075-8.
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.
心血管疾病是高收入国家的主要死亡原因，预计到 2030 年将成为全球主要死亡原因。目前的大部分研究工作都旨在确定、改变和治疗个体层面的风险因素。尽管取得了重大进展，但在空间和时间上仍然存在着巨大的不平等。尽管世界各地的发病率都在不同程度地上升，但各种心血管风险因素的流行程度的增加幅度已促使研究工作转向研究风险因素的原因（即“原因的原因”），其中包括健康的社会决定因素。健康的社会决定因素反映了社会环境对特定社区人群健康的影响。健康的社会决定因素失衡归因于国家间和国家内观察到的健康不平等。本文综述了全球范围内健康的社会决定因素的作用，描述了流行病学的转变和被称为“反向社会梯度”的持续趋势。还将检查加拿大的社会决定因素的影响，包括来自族裔和原住民社区的数据。提出了减少社会因素对心血管健康影响的可能解决方案和未来方向。
