Social Determinants of Health Tied to Atherosclerotic Heart Disease in Black Americans

(HealthDay News) — Both individual- and area-level social determinants of health (SDOH) are associated with atherosclerotic cardiovascular disease (ASCVD) risk, according to a study published online April 26 in JAMA Network Open.

Mengying Xia, M.P.H., from Columbia University in New York City, and colleagues examined the association of SDOH at both individual and area levels with ASCVD risks. The analysis included 26,316 participants (aged 40 to 79 years without a history of ASCVD) from four large U.S. cohort studies, with baseline data collected from 1995 to 2007 and a median follow-up of 13.0 years.

The researchers found that 44.7 percent had at least one adverse individual-level SDOH and 41.5 percent had at least one adverse area-level SDOH. At both the individual and area levels, SDOH, including low education, low income, and unemployment, were associated with an increased risk for ASCVD. Model discrimination did not change by adding area-level SDOH alone to the pooled cohort equations (PCEs) but modestly improved calibration. There were modest improvements in both discrimination and calibration when adding both individual- and area-level SDOH to the PCEs among non-Hispanic Black individuals (change in C index, 0.0051; change in scaled integrated Brier score [IBS], 0.396 percent), as well as improvement in calibration in White individuals (change in scaled IBS, 0.274 percent).

“Both individual- and area-level SDOH may be considered in future development of ASCVD risk assessment tools, particularly among Black individuals,” the authors write.

One author reported owning stock in MedExplain.

What is atherosclerotic cardiovascular disease (ASCVD)?

Atherosclerotic cardiovascular disease (ASCVD) is a major health threat, particularly for Black Americans. It’s a progressive condition where fatty deposits, called plaque, build up within artery walls. This narrowing restricts blood flow, potentially leading to heart attack, stroke, and other cardiovascular complications.

Several factors contribute to plaque formation, including high blood pressure, unhealthy cholesterol levels, diabetes, and smoking. However, Black Americans face a higher risk of ASCVD even when accounting for these traditional risk factors. Research suggests this disparity might be due to a combination of biological and social determinants of health.

Biological factors potentially play a role. Some studies suggest Black Americans may have a genetic predisposition for earlier development and faster progression of atherosclerosis. Additionally, chronic low-grade inflammation, a risk factor for ASCVD, may be more prevalent in Black populations.

Social determinants of health also contribute to the increased risk. Black communities often face higher rates of poverty, limited access to quality healthcare, and exposure to environmental stressors like air pollution [3]. These factors can worsen traditional risk factors, creating a cycle that disadvantages cardiovascular health.

Social Determinants of Health Tied to Atherosclerotic Heart Disease in Black Americans

For instance, limited access to healthy food options can contribute to poor diet, while chronic stress can elevate blood pressure. Discrimination in healthcare settings can also lead to delays in diagnosis and treatment, further impacting outcomes.

The earlier onset and increased burden of ASCVD in Black Americans highlight the need for a multi-pronged approach. Public health strategies promoting healthy lifestyles, reducing social stressors, and improving access to healthcare are crucial. Additionally, research exploring the unique biological contributors to ASCVD risk in Black populations can inform targeted prevention and treatment strategies.

What are social determinants of health (SDOH)?

Social determinants of health (SDOH), as defined by the World Health Organization (WHO), are the circumstances in which we are born, grow, work, live, and age. These circumstances encompass a broad range of forces and systems, including economic policies, social norms, and political environments. Understanding SDOH is crucial because they shape health inequities, the unfair and avoidable differences in health seen within and between populations.

SDOH encompass various domains that can influence health positively or negatively. Imagine a spectrum – on one end, factors like safe housing, access to quality education, and economic stability can promote good health. On the other end, factors like discrimination, unemployment, and living in a polluted environment can have detrimental health consequences. For instance, a community with limited access to grocery stores with fresh produce might struggle with healthy eating habits, impacting overall nutrition and potentially increasing chronic disease risk.

The impact of SDOH is evident across the socioeconomic spectrum. Research shows a social gradient in health, where those with lower socioeconomic positions tend to experience poorer health outcomes. This highlights the need to address SDOH to achieve health equity, where everyone has a fair and just opportunity to be as healthy as possible.

By acknowledging the influence of SDOH, we can move beyond solely focusing on individual health behaviors. This broader approach allows us to consider how social policies, community resources, and economic opportunities can be leveraged to create conditions that support everyone’s health and well-being.

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