Department of Primary Care & Mental Health, Institute of Population Health, University of Liverpool, 1-3 Brownlow Street, Liverpool, L69 3GL, UK.
King's Health Economics, Health Services and Population Research, Department of Psychiatry, Psychology & Neuroscience, King's College London, David Goldberg Centre 18 De Crespigny Park, London, SE5 8AF, UK.
Br Med Bull. 2023 Dec 11;148(1):22-41. doi: 10.1093/bmb/ldad025.
Cardiovascular disease (CVD) has shown significant health inequalities for people with low socioeconomic status associated with more risk factors. This review was to synthesize interventions that targeted CVD risks and outcomes among socioeconomically disadvantaged populations and to understand the impact associated with these interventions.
Cochrane CENTRAL, MEDLINE, Embase, PsycINFO and CINAHL were searched for records published in the last decade using a systematic search strategy, complemented by screening the reference lists and citation indexes. Nineteen studies were included and a narrative synthesis with the effect direction plot was undertaken in which studies, interventions, participants and outcomes were examined according to the intervention type focusing on behaviours, lifestyle, education, medication and monitoring.
No universal definition of disadvantaged socioeconomic status was used with common factors relating to racial/ethnic minorities, low income and low or no health insurance. Mixed effects of interventions were reported on clinical outcomes including weight, body mass index, blood pressure, glycated haemoglobin and cholesterol.
Inconsistent effect was reported due to a large variety of settings, participants and intervention components although they are considered necessary to address the complex health needs of socioeconomically disadvantaged populations.
There is inadequate evidence to determine whether any of the intervention types are effective in optimising lipids management for socioeconomically disadvantaged populations.
Research is needed with mixed evidence using real world evaluation and lived experience combined with health economic evaluation, on both mental and physical health outcomes.
心血管疾病(CVD)在与更多风险因素相关的社会经济地位较低的人群中表现出显著的健康不平等。本综述旨在综合针对社会经济弱势群体的 CVD 风险和结局的干预措施,并了解这些干预措施的影响。
使用系统检索策略在 Cochrane CENTRAL、MEDLINE、Embase、PsycINFO 和 CINAHL 中检索过去十年发表的记录,并用筛选参考文献和引文索引进行补充。纳入了 19 项研究,并进行了叙述性综合,其中包括根据干预类型(重点是行为、生活方式、教育、药物和监测)对研究、干预、参与者和结局进行分析的效果方向图。
没有使用普遍的劣势社会经济地位定义,常见因素与少数族裔、低收入和低或无健康保险有关。干预对临床结局(包括体重、体重指数、血压、糖化血红蛋白和胆固醇)的混合效果的报道不一致。
由于各种不同的环境、参与者和干预因素,报告的效果不一致,尽管这些因素被认为是解决社会经济弱势群体复杂健康需求的必要条件。
由于混合证据不足,尚无足够证据确定任何干预类型是否能有效优化社会经济弱势群体的血脂管理。
需要使用真实世界评估和生活经验与健康经济评估相结合的混合证据,对心理健康和身体健康结果进行研究。