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Social Determinants of Cardiovascular Diseases
Public Health Reviews volume 33, pages601–622(2011)
Social determinants of health can be understood as the social conditions in which individuals live and work; conditions that are shaped by the distribution of power, income and resources, as much on a global and national level as on a local level. Social determinants of cardiovascular diseases are found largely outside the healthcare and preventative healthcare systems; but it is important to think in terms of chains of cause and effect, which enable us to see these determinants at work within the system of curative and preventative care, including the management of traditional risk factors. Taking a dynamic perspective on these social determinants of health, and in particular viewing them in a biological and epidemiological context, emphasizes the fact that intervention as early in life as possible is desirable in order to prevent cardiovascular diseases. It is important to act early, before childhood adversities in these critical periods are permanently or irrevocably recorded in the body. In terms of behaviour, focussing health education on adults runs counter to the fact that, with age, it is increasingly difficult to change our behaviour and to overcome biological damage already inflicted. In an area where attention has long been focussed on individual risk factors, underlining the fact that these factors act from infancy allows us to highlight the collective influences on the development of these diseases. Reflecting on health determinants in this way suggests that perhaps the population strategy proposed by Geoffrey Rose may lead to an increase in social inequalities if the modest decrease in risk factors, for example in terms of nutrition, involves the population categories initially most privileged.
O’Flaherty M, Bishop J, Redpath A, McLaughlin T, Murphy D, Chalmers J, et al. Coronary heart disease mortality among young adults in Scotland in relation to social inequalities: time trend study. BMJ. 2009;339:b2613.
Saurel-Cubizolles MJ, Chastang JF, Menvielle G, Leclerc A, Luce D; EDISC group. Social inequalities in mortality by cause among men and women in France. J Epidemiol Community Health. 2009;63:197–202.
Kreatsoulas C, Anand SS. The impact of social determinants on cardiovascular disease. Can J Cardiol. 2010;26:8C–13C.
Helman, in Blakely AB, Woodward AJ. Ecological effects in multi-level studies. J Epidemiol Community Health. 2000;54:367–74.
Lynch JW, Smith GD, Kaplan GA, House JS. Income inequality and mortality: importance to health of individual income, psychosocial environment, or material conditions. BMJ. 2000;320:1200–4.
Marmot M, Wilkinson RG. Psychosocial and material pathways in the relation between income and health: a response to Lynch et al. BMJ. 2001;322:1233–6.
Leclerc A, Kaminski M, Lang T. Inégaux face à la santé: du constat à l’action. Paris: La Découverte Ed. 2008. p.298.
Huisman M, Kunst AE, Bopp M, Borgan JK, Borrell C, Costa G, et al. Educational inequalities in cause-specific mortality in middle-aged and older men and women in eight western European populations. Lancet. 2005;365:493–500.
Jood K, Redfors P, Rosengren A, Blomstrand C, Jern C. Self-perceived psychological stress and ischemic stroke: a case-control study. BMC Med. 2009;7:8.
Surtees PG, Wainwright NWJ, Luben RL, Wareham NJ, Bingham SA, Khaw KT. Adaptation to social adversity is associated with stroke incidence — evidence from the EPIC-Norfolk prospective cohort study. Stroke. 2007;38:1447–53.
Rosengren A, Hawken S, Ounpuu S, Sliwa K, Zubaid M, Almahmeed WA, et al.; INTERHEART investigators. Association of psychosocial risk factors with risk of acute myocardial infarction in 11,119 cases and 13,648 controls from 52 countries (the INTERHEART study): case-control study. Lancet. 2004; 364:953–62.
Bosma H, Peter R, Siegrist J, Marmot M. Two alternative job stress models and the risk of coronary heart disease. Am J Public Health. 1998;88:68–74.
Chandola T et al. Work stress and coronary heart disease: what are the mechanisms? Eur Heart J. 2008;29:640–8.
Bourbonnais R, Brisson C, Malenfant R, Vézina M. Health care restructuring, work environment, and health of nurses. Am J Ind Med. 2005;47:54–64.
Kivimäki M, Leino-Arjas P, Luukkonen R, Riihimäki H, Vahtera J, Kirjonen J. Work stress and risk of cardiovascular mortality: prospective cohort study of industrial employees. BMJ. 2002;325:857.
De Gaudemaris R, Levant A, Ehlinger V, Hérin F, Lepage B, Soulat JM, et al. Blood pressure and working conditions in hospital nurses and nursing assistants. The ORSOSA study. Arch Cardiovasc Dis. 2011;104:97–103.
Lipovetzky N, Hod H, Roth A, Kishon Y, Sclarovsky S, Green MS. Emotional events and anger at the workplace as triggers for a first event of the acute coronary syndrome: a case-crossover study. Isr Med Assoc J. 2007;9:310–315.
Pickering TG. Reflections in hypertension: work and blood pressure. J Clin Hypertens (Greenwich). 2004;6:403–405.
Vahtera J, Kivimaki M, Pentti J, Linna A, Virtanen M, Virtanen P, et al. Organisational downsizing, sickness absence, and mortality: 10-town prospective cohort study. BMJ. 2004;328:555–60.
Holt-Lunstadt J, Smith TB, Layton JB. Social relationships and mortality risk: a meta-analytic review. PLoS Med. 2010;7:1–20.
Bhaskaran K, Hajat S, Haines A, Herrett E, Wilkinson P, Smeeth L. Effects of air pollution on the incidence of myocardial infarction. Heart. 2009;95:1746–59.
Deguen S, Zmirou-Navier D. Social inequalities resulting from health risks related to ambient air quality — a European review. Eur J Public Health. 2010;20:27–35.
Finkelstein MM., Jerrett M., Sears MR. Environmental inequality and circulatory disease mortality gradients. J. Epidemiol. Community Health. 2005;59:481–7.
Bhaskaran K, Hajat S, Haines A, Herrett E, Wilkinson P, Smeeth L. Effects of ambient temperature on the incidence of myocardial infarction. Heart. 2009;95:1760–9.
Mitchell R, Popham F. Effect of exposure to natural environment on health inequalities: an observational population study. Lancet. 2008;372:1655–60.
Primatesta P, Brookes M. Cardiovascular disease: prevalence and risk factors. In: B Erens, P Primatesta and G Prior, editors. Health survey for England: the health of minority ethnic groups. London: The Stationery Office; 2001.
Nazroo J, Davey Smith G. The contribution of socio-economic position to health differentials between ethnic groups: evidence from the United States and Britain. In: Health and Ethnicity. Macbeth H, Shetty P, editors. London: Taylor and Francis; 2001.
Brondolo E, Love EE, Pencille M, Schoenthaler A, Ogedegbe G. Racism and hypertension: a review of the empirical evidence and implications for clinical practice. Am J Hypertens. 2011;24:518–29.
Stringhini S, Dugravot A, Shipley M, Goldberg M, Zins M, Kivimäki M, et al. Health behaviours, socioeconomic status, and mortality: further analyses of the British Whitehall II and the French GAZEL prospective cohorts. PLoS Med. 2011;8:e1000419.
Beauchamp A, Peeters A, Wolfe R, Turrell G, Harriss LR, Giles GG, et al. Inequalities in cardiovascular disease mortality: the role of behavioural, physiological and social risk factors. J Epidemiol Community Health. 2010;64:542–8.
Kelly-Irving M, Mulot S, Inamo J, Ruidavets JB, Atallah A, Lang T. Improving stroke prevention in the French West Indies: limits to lay knowledge of risk factors. Stroke. 2010;41:2637–44.
Lombrail P, Pascal J, Lang T. Accès au système de soins et inégalités sociales de santé: que sait-on de l’accès secondaire ? Santé, Société et Solidarité. Revue de l’observatoire Franco-québecois de la Santé et de la Solidarité. 2004;No2:61–71.
Steptoe A, Marmot M. The role of psychobiological pathways in socio-economic inequalities in cardiovascular disease risk. Eur Heart. 2002;23:13–25.
Lang T. Ignoring social factors in clinical decision rules: a contribution to health inequalities? Eur J Public Health. 2005;15:441.
Graham I, Atar D, Borch-Johnsen K, Boysen G, Burell G, Cifkova R, et al. European guidelines on cardiovascular disease prevention in clinical practice: executive summary. Atherosclerosis. 2007;194:1–45.
Conroy RM, Pyorala K, Fitzgerald AP, Sans S, Menotti A, De Backer G, et al. Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. Eur Heart J. 2003;24:987–1003.
Kannel WB, D’Agostino RB, Sullivan L, Wilson PW. Concept and usefulness of cardiovascular risk profiles. Am Heart J. 2004;148:16–26.
Brindle P, Beswick A, Fahey T, Ebrahim S. Accuracy and impact of risk assessment in the primary prevention of cardiovascular disease: a systematic review. Heart. 2006;92:1752–9.
Tunstall-Pedoe H, Woodward M. By neglecting deprivation, cardiovascular risk scoring will exacerbate social gradients in disease. Heart. 2006;92:307–10.
Lepage B, Amouyel P, Arveiler D, Ferrières J, Ducimetière P, Lang T. Could clinical decision rules relying on cardiovascular risk models increase psychosocial inequalities in health? Results from the PRIME cohort study. Prev Med. 2011;52:439–44.
Hippisley-Cox J, Coupland C, Vinogradova Y, Robson J, May M, Brindle P. Derivation and validation of QRISK, a new cardiovascular disease risk score for the United Kingdom: prospective open cohort study. BMJ. 2007;335:136.
Hippisley-Cox J, Coupland C, Vinogradova Y, Robson J, Minhas R, Sheikh A, et al. Predicting cardiovascular risk in England and Wales: prospective derivation and validation of QRISK2. BMJ. 2008;336:1475–82.
de Gaudemaris R, Lang T, Chatellier G, Larabi L, Lauwers-Cances V, Maitre A, et al. Socioeconomic inequalities in hypertension prevalence and care: the IHPAF Study. Hypertension. 2002;39:1119–25.
Lang T, Ducimetière P, Arveiler D, Amouyel P, Ferrières J, Ruidavets JB, et al. Is hospital care involved in inequalities in coronary heart disease mortality? J Epidemiol Community Health. 1998;52:665–71.
Arber S, McKinlay J, Adams A, Marceau L, Link C, O’Donnell A. Patient characteristics and inequalities in doctor’s diagnostic and management strategies relating to CHD: a video-simulation experiment. Soc Sci Med. 2006;62:103–15.
Schieber AC, Kelly-Irving M, Rolland C, Afrite A, Cases C, Dourgnon P, et al. Do doctors and patients remember the same elements of the cardiovascular risk-factors’ management after the consultation? The INTERMEDE study. Br J Gen Pract. 2011;61:178–83.
Martin E, Russell D, Goodwin S, Chapman R, North M, Sheridan P. Why patients consult and what happen when they do. BMJ. 1991;303:289–92.
Taira DA, Safran DG, Seto TB, Rogers WH, Tarlov AR. The relationship between patient income and physician discussion of health risk factors. JAMA. 1997;278:1412–7.
Arber S, McKinlay J, Adams A, Marceau L, Link C, O’Donnell A. Influence of patient characteristics on doctors’ questioning and lifestyle advice for coronary heart disease: a UK/US video experiment. Brit J Gen Pract. 2004;54:673–8.
Lang T, Kelly-Irving M, Delpierre C. Inégalités sociales de santé: du modèle épidémiologique à l’intervention. Enchaînements et accumulations au cours de la vie in (English: Inequalities in health: from the epidemologic model towards intervention Pathways and accumulations along the lifecourse.) Rev Epidemiol Santé Publique. 2009;57:429–35
Korkeila J, Vahtera J, Korkeila K, Kivimäki M, Sumanen M, Koskenvuo K, et al. Childhood adversities as predictors of incident coronary heart disease and cerebrovascular disease. Heart. 2010;96:298–303.
Forsdahl A. Are poor living conditions in childhood and adolescence an important risk factor for arteriosclerotic disease? Brit J Prev Soc Med. 1977;31:91–5.
Barker DJP, Osmond C. Infant mortality, childhood nutrition, and ischaemic heart disease in England and Wales. Lancet. 1986;1(8489):1077–81.
Barker DJP. Mothers, babies and health in later life. Edinburgh: Churchill Livingstone; 1998.
Hardy R, Kuh D, Langenberg C. Wadsworth MEJ. Birthweight, childhood social class, and change in adult blood pressure in the 1946 British birth cohort. Lancet. 2003;362:1178–83.
Roberts CB, Couper DJ, Chang PP, James SA, Rosamond WD, Heiss G. Influence of life-course socioeconomic position on incident heart failure in blacks and whites: the Atherosclerosis Risk in Communities Study. Am J Epidemiol. 2010;172(6):717–27.
Roseboom TJ, Van der Meulen JHP, Osmond C. Barker DJP. Coronary heart disease after prenatal exposure to the Dutch famine: 1944–1945. Heart. 2000;84:595–8.
Wamala SP, Lynch J, Kaplan GA. Women’s exposure to early and later life socioeconomic disadvantage and coronary heart disease risk: the Stockholm female coronary risk study. Int J Epidemiol. 2001;30:275–84.
Shonkoff JP, Boyce WT, McEwen BS. Neuroscience, molecular biology, and the childhood roots of health disparities: building a new framework for health promotion and disease prevention. JAMA. 2009;301:2252–9.
Dong M, Giles WH, Felitti VJ, Dube SR, Williams JE, Chapman DP, et al. Insights into causal pathways for ischemic heart disease: adverse childhood experiences study. Circulation. 2004;110:1761–6.
Thomas C, Hypponen E, Power C. Obesity and type 2 diabetes risk in midadult life: The role of childhood adversity. Pediatrics. 2008;121:E1240–9.
Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. Am J Prev Med. 1998;14:245–58.
Whitehead M, Dahlgren G. Concepts and principles for tackling social inequities in health. Copenhagen: WHO Europe; 2006.
Rose G. The Strategy of Preventive Medicine. Oxford: Oxford University Press; 1992.
Leal C, Chaix B. The influence of geographic life environments on cardiometabolic risk factors: a systematic review, a methodological assessment and a research agenda. Obes Rev. 2011;12:217–30.
Chaix B, Ducimetière P, Lang T, Haas B, Montaye M, Ruidavets JB, et al. Residential environment and blood pressure in the PRIME Study: is the association mediated by body mass index and waist circumference? J Hypertension. 2008;26:1078–84.
Chaix B, Kestens Y, Bean K, Leal C, Karusisi N, Meghiref K, et al. Cohort Profile: Residential and non-residential environments, individual activity spaces and cardiovascular risk factors and diseases—The RECORD Cohort Study. Int J Epidemiol. 2011 Jul 7. [Epub ahead of print]
Timio M, Verdecchia P, Venanzi S, Gentili S, Ronconi M, Francucci B, et al. Age and blood pressure changes. A 20 year follow up study in nuns in a secluded order. Hypertension. 1988;12:457–61.
Koenen KC, Aiello AE, Bakshis E, Amstadter AB, Ruggiero KJ, Acierno R, et al. Modification of the association between serotonin transporter genotype and risk of posttraumatic stress disorder in adults by county-level social environment. Am J Epidemiol. 2009;169:704–11.
Frohlich KL, Potvin L. Transcending the known in public health practice: the inequality paradox: the population approach and vulnerable populations. Am J Public Health. 2008;98:216–21.
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Lang, T., Lepage, B., Schieber, A. et al. Social Determinants of Cardiovascular Diseases. Public Health Rev 33, 601–622 (2011) doi:10.1007/BF03391652