Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Department of Biological and Health Sciences, University of Brasilia, Campus Universitario - Centro Metropolitano, Ceilandia Campus, Brasilia, FD, Brazil.
Ann Epidemiol. 2022 Dec;76:20-38. doi: 10.1016/j.annepidem.2022.09.006. Epub 2022 Oct 1.
This systematic review synthesizes research published from January 2010-July 2022 on the social determinants of ideal cardiovascular health (CVH) carried out around the world and compares trends in high-income countries (HICs) to those in low- and middle-income countries (LMICs). 41 studies met inclusion criteria (n = 28 HICs, n = 13 LMICs). Most were from the United States (n = 22) and cross-sectional (n = 33), and nearly all evaluated associations among adults. Among studies conducted in LMICs, nearly all were from middle-income countries and only one was carried out in low-income country. Education (n = 24) and income/wealth (n = 17) were the most frequently examined social determinants in both HICs and LMICs. Although most studies assessed ideal CVH using reliable and valid methods (n = 24), only 7 used criteria pre-defined by the American Heart Association to characterize ideal levels of each CVH metric. Despite heterogeneity in how outcome measures were derived and analyzed, consistent associations were evident between multiple markers of higher social status (i.e. greater education, income/wealth, socioeconomic status, racial/ethnic majority status) and greater levels of ideal CVH across both country contexts. Gaps in the literature include evidence from LMICs and HICs other than the United States, longitudinal research, and investigations of a wider array of social determinants beyond education and income/wealth.
本系统评价综合了 2010 年 1 月至 2022 年 7 月期间发表的关于全球心血管健康理想状态的社会决定因素的研究,并比较了高收入国家(HICs)和中低收入国家(LMICs)的趋势。41 项研究符合纳入标准(n=28 个 HICs,n=13 个 LMICs)。大多数研究来自美国(n=22)且为横断面研究(n=33),且几乎所有研究都评估了成年人之间的关联。在 LMICs 中进行的研究中,几乎都来自中等收入国家,只有一项研究在低收入国家进行。在 HICs 和 LMICs 中,教育(n=24)和收入/财富(n=17)是最常被研究的社会决定因素。尽管大多数研究(n=24)使用可靠有效的方法评估理想的 CVH,但只有 7 项研究使用了美国心脏协会预先定义的标准来描述每个 CVH 指标的理想水平。尽管结果衡量指标的推导和分析存在异质性,但在这两种国家背景下,多个较高社会地位(即更高的教育程度、收入/财富、社会经济地位、种族/民族多数地位)的标志与理想 CVH 水平之间存在一致的关联。文献中的空白包括来自除美国以外的 LMICs 和 HICs 的证据、纵向研究以及对教育和收入/财富之外更广泛社会决定因素的调查。