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Socioeconomic status and cardiovascular disease: risks and implications for care

Abstract

Socioeconomic status (SES) refers to an individual's social position relative to other members of a society. Low SES is associated with large increases in cardiovascular disease (CVD) risk in men and women. The inverse association between SES and CVD risk in high-income countries is the result of the high prevalence and compounding effects of multiple behavioral and psychosocial risk factors in people of low SES. However, strong and consistent evidence shows that parental SES, childhood and early-life factors, and inequalities in health services also contribute to elevated CVD risk in people of low SES who live in high-income countries. In addition, place of residence can affect CVD risk, although the data on the influence of wealth distribution and work-related factors are inconsistent. Studies on the effects of SES on CVD risk in low-income and middle-income countries is scarce, but evidence is emerging that the increasing wealth of these countries is beginning to lead to replication of the patterns seen in high-income countries. Clinicians should address the association between SES and CVD by incorporating SES into CVD risk calculations and screening tools, reducing behavioral and psychosocial risk factors via effective and equitable primary and secondary prevention, undertaking health equity audits to assess inequalities in care provision and outcomes, and by use of multidisciplinary teams to address risk factors over the life course.

Key Points

  • Low socioeconomic status is linked to large increases in cardiovascular disease risk in men and women in high-income countries

  • In high-income countries, people of low socioeconomic status are more likely than people of high socioeconomic status to have modifiable and behavioral risk factors for cardiovascular disease

  • Psychosocial factors, inequalities in health services, and the influence of area of residence strengthen the association between socioeconomic status and cardiovascular disease risk

  • Cardiovascular disease is a huge problem in low-income and middle-income countries; as middle-income countries become wealthier, patterns in socioeconomic status and cardiovascular disease of high-income countries are replicated

  • Cardiovascular disease risk should be addressed by incorporating socioeconomic status into screening and risk calculations and reducing behavioral and psychosocial risk factors via equitable care

  • Health equity audits should be used to examine inequalities in health-care provisions and outcomes, and risk factors should be addressed across the individual's life course by multidisciplinary teams

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Acknowledgements

Funding for the work upon which this Review is based was provided by Public Health Agency of Canada in 2008. A. M. Clark receives support from the Alberta Heritage Foundation for Medical Research and the Canadian Institutes for Health Research. The authors thank Professor H. Tunstall-Pedoe (University of Dundee, UK) for information on the ASSIGN score and Thane Chambers (Research Librarian, University of Alberta, Canada) for assistance with the literature search.

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Clark, A., DesMeules, M., Luo, W. et al. Socioeconomic status and cardiovascular disease: risks and implications for care. Nat Rev Cardiol 6, 712–722 (2009). https://doi.org/10.1038/nrcardio.2009.163

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