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Social Determinants of Cardiovascular Diseases

Public Health Reviews volume 33, pages601–622(2011)Cite this article

Abstract

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.

References

  1. 1.

    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.

    Article  Google Scholar 

  2. 2.

    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.

    Article  PubMed  Google Scholar 

  3. 3.

    Kreatsoulas C, Anand SS. The impact of social determinants on cardiovascular disease. Can J Cardiol. 2010;26:8C–13C.

    Article  PubMed  PubMed Central  Google Scholar 

  4. 4.

    Helman, in Blakely AB, Woodward AJ. Ecological effects in multi-level studies. J Epidemiol Community Health. 2000;54:367–74.

    Article  Google Scholar 

  5. 5.

    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.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  6. 6.

    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.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  7. 7.

    Leclerc A, Kaminski M, Lang T. Inégaux face à la santé: du constat à l’action. Paris: La Découverte Ed. 2008. p.298.

    Google Scholar 

  8. 8.

    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.

    Article  PubMed  Google Scholar 

  9. 9.

    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.

    Article  Google Scholar 

  10. 10.

    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.

    Article  PubMed  Google Scholar 

  11. 11.

    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.

    Article  PubMed  Google Scholar 

  12. 12.

    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.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  13. 13.

    Chandola T et al. Work stress and coronary heart disease: what are the mechanisms? Eur Heart J. 2008;29:640–8.

    Article  PubMed  Google Scholar 

  14. 14.

    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.

    Article  PubMed  Google Scholar 

  15. 15.

    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.

    Article  PubMed  PubMed Central  Google Scholar 

  16. 16.

    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.

    Article  PubMed  Google Scholar 

  17. 17.

    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.

    PubMed  Google Scholar 

  18. 18.

    Pickering TG. Reflections in hypertension: work and blood pressure. J Clin Hypertens (Greenwich). 2004;6:403–405.

    Article  Google Scholar 

  19. 19.

    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.

    Article  PubMed  PubMed Central  Google Scholar 

  20. 20.

    Holt-Lunstadt J, Smith TB, Layton JB. Social relationships and mortality risk: a meta-analytic review. PLoS Med. 2010;7:1–20.

    Google Scholar 

  21. 21.

    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.

    CAS  Article  PubMed  Google Scholar 

  22. 22.

    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.

    Article  PubMed  Google Scholar 

  23. 23.

    Finkelstein MM., Jerrett M., Sears MR. Environmental inequality and circulatory disease mortality gradients. J. Epidemiol. Community Health. 2005;59:481–7.

    Article  PubMed  PubMed Central  Google Scholar 

  24. 24.

    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.

    CAS  Article  PubMed  Google Scholar 

  25. 25.

    Mitchell R, Popham F. Effect of exposure to natural environment on health inequalities: an observational population study. Lancet. 2008;372:1655–60.

    Article  PubMed  Google Scholar 

  26. 26.

    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.

    Google Scholar 

  27. 27.

    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.

    Google Scholar 

  28. 28.

    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.

    Article  PubMed  Google Scholar 

  29. 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.

    Article  Google Scholar 

  30. 30.

    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.

    Article  PubMed  Google Scholar 

  31. 31.

    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.

    Article  PubMed  Google Scholar 

  32. 32.

    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.

    Google Scholar 

  33. 33.

    Steptoe A, Marmot M. The role of psychobiological pathways in socio-economic inequalities in cardiovascular disease risk. Eur Heart. 2002;23:13–25.

    CAS  Article  Google Scholar 

  34. 34.

    Lang T. Ignoring social factors in clinical decision rules: a contribution to health inequalities? Eur J Public Health. 2005;15:441.

    Article  PubMed  Google Scholar 

  35. 35.

    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.

    CAS  Article  PubMed  Google Scholar 

  36. 36.

    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.

    CAS  Article  PubMed  Google Scholar 

  37. 37.

    Kannel WB, D’Agostino RB, Sullivan L, Wilson PW. Concept and usefulness of cardiovascular risk profiles. Am Heart J. 2004;148:16–26.

    Article  PubMed  Google Scholar 

  38. 38.

    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.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  39. 39.

    Tunstall-Pedoe H, Woodward M. By neglecting deprivation, cardiovascular risk scoring will exacerbate social gradients in disease. Heart. 2006;92:307–10.

    CAS  Article  PubMed  Google Scholar 

  40. 40.

    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.

    Article  PubMed  Google Scholar 

  41. 41.

    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.

    Article  PubMed  PubMed Central  Google Scholar 

  42. 42.

    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.

    Article  PubMed  PubMed Central  Google Scholar 

  43. 43.

    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.

    Article  PubMed  Google Scholar 

  44. 44.

    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.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  45. 45.

    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.

    Article  PubMed  Google Scholar 

  46. 46.

    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.

    Article  Google Scholar 

  47. 47.

    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.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  48. 48.

    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.

    CAS  Article  PubMed  Google Scholar 

  49. 49.

    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.

    Google Scholar 

  50. 50.

    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

    CAS  Article  PubMed  Google Scholar 

  51. 51.

    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.

    Article  PubMed  Google Scholar 

  52. 52.

    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.

    CAS  Google Scholar 

  53. 53.

    Barker DJP, Osmond C. Infant mortality, childhood nutrition, and ischaemic heart disease in England and Wales. Lancet. 1986;1(8489):1077–81.

    CAS  Article  PubMed  Google Scholar 

  54. 54.

    Barker DJP. Mothers, babies and health in later life. Edinburgh: Churchill Livingstone; 1998.

    Google Scholar 

  55. 55.

    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.

    Article  PubMed  Google Scholar 

  56. 56.

    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.

    Article  PubMed  PubMed Central  Google Scholar 

  57. 57.

    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.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  58. 58.

    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.

    CAS  Article  PubMed  Google Scholar 

  59. 59.

    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.

    CAS  Article  PubMed  Google Scholar 

  60. 60.

    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.

    Article  PubMed  Google Scholar 

  61. 61.

    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.

    Article  Google Scholar 

  62. 62.

    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.

    CAS  Article  PubMed  Google Scholar 

  63. 63.

    Whitehead M, Dahlgren G. Concepts and principles for tackling social inequities in health. Copenhagen: WHO Europe; 2006.

    Google Scholar 

  64. 64.

    Rose G. The Strategy of Preventive Medicine. Oxford: Oxford University Press; 1992.

    Google Scholar 

  65. 65.

    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.

    CAS  Article  PubMed  Google Scholar 

  66. 66.

    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.

    CAS  Article  Google Scholar 

  67. 67.

    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]

    Google Scholar 

  68. 68.

    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.

    CAS  Article  PubMed  Google Scholar 

  69. 69.

    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.

    Article  PubMed  PubMed Central  Google Scholar 

  70. 70.

    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.

    Article  PubMed  PubMed Central  Google Scholar 

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  1. Département d’Epidémiologie et santé publique, UMR Inserm-Université Paul Sabatier 1027, Institut Fédératif d’Etudes et de Recherche Interdisciplinaires Santé Société (IFERISS), Faculté de Médecine, 37, Allées Jules Guesde, 31073, Toulouse, France

    Thierry Lang MD, PhD, Benoit Lepage MD, Anne-Cécile Schieber MD, Sébastien Lamy & Michelle Kelly-Irving PhD

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  1. Thierry Lang MD, PhD
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  2. Benoit Lepage MD
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Correspondence to Thierry Lang MD, PhD.

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Lang, T., Lepage, B., Schieber, A. et al. Social Determinants of Cardiovascular Diseases. Public Health Rev 33, 601–622 (2011). https://doi.org/10.1007/BF03391652

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