School of Medicine.
Department of Medicine.
Curr Opin Cardiol. 2021 Sep 1;36(5):572-579. doi: 10.1097/HCO.0000000000000893.
Social determinants of health (SDOH) describe conditions in one's environment that have an impact on health, quality-of-life, outcomes, and risks. These include income, education, employment, culture, language, healthcare access, social support, race, ethnicity, structural racism, discrimination, social support, neighborhood characteristics, and others. SDOH manifest as persistent inequalities in cardiovascular risk factors and disease, and, therefore, contribute to cardiovascular disease (CVD)-related morbidity and mortality. This article reviews how SDOH affect CVD risk and the role they play in CVD prevention.
The 2019 American College of Cardiology/American Heart Association (AHA) guideline on the primary prevention of CVD recommends that clinicians evaluate SDOH on an individual basis to inform treatment decisions for CVD prevention efforts. Recent evidence shows that low socioeconomic status, adverse childhood experiences, less social support, reduced health literacy, and limited healthcare access are associated with higher CVD risk and poorer health outcomes. A 2020 AHA statement emphasized the role of structural racism as a fundamental driver of health disparities. The AHA 2030 Impact Goals state a desire to achieve health equity by identifying and removing barriers to healthcare access and quality.
SDOH affect CVD prevention efforts. The SDOH that affect cardiovascular risk factors, diseases, and outcomes are complex and intersect. Addressing them can be challenging and will require a multilevel and multidisciplinary approach, involving public health measures, changes in health systems, team-based care, and dismantling of structural racism. More studies are needed to investigate the effect of interventions that improve SDOH and prevent CVD or lower CVD risk.
健康的社会决定因素（SDOH）描述了一个人所处环境中对健康、生活质量、结果和风险有影响的条件。这些因素包括收入、教育、就业、文化、语言、医疗保健可及性、社会支持、种族、民族、结构性种族主义、歧视、社会支持、邻里特征等。SDOH 表现为心血管危险因素和疾病的持续不平等，因此导致心血管疾病（CVD）相关发病率和死亡率。本文综述了 SDOH 如何影响 CVD 风险以及它们在 CVD 预防中的作用。
2019 年美国心脏病学会/美国心脏协会（AHA）关于 CVD 一级预防的指南建议临床医生根据个人情况评估 SDOH，为 CVD 预防措施的治疗决策提供信息。最近的证据表明，社会经济地位低、不良的童年经历、较少的社会支持、较低的健康素养和有限的医疗保健可及性与更高的 CVD 风险和较差的健康结果相关。2020 年 AHA 声明强调了结构性种族主义作为健康差异根本驱动因素的作用。AHA 2030 年影响目标表明，希望通过确定和消除医疗保健可及性和质量方面的障碍来实现健康公平。
SDOH 影响 CVD 预防工作。影响心血管危险因素、疾病和结果的 SDOH 是复杂且相互交织的。解决这些问题具有挑战性，需要采取多层次和多学科的方法，包括公共卫生措施、医疗体系改革、团队护理和消除结构性种族主义。需要更多的研究来调查改善 SDOH 和预防 CVD 或降低 CVD 风险的干预措施的效果。
