Social Determinants of Health and Disparities in Hypertension and Cardiovascular Diseases

Abstract

High blood pressure causes over 10 million preventable deaths annually globally. Populations in low- and middle-income countries suffer the most, experiencing increased uncontrolled blood pressure and cardiovascular disease (CVD) deaths. Despite improvements in high-income countries, disparities persist, notably in the United States, where Black individuals face up to 4× higher CVD mortality than White individuals. Social determinants of health encompass complex, multidimensional factors linked to an individual’s birthplace, upbringing, activities, residence, workplaces, socioeconomic and environmental structures, and significantly affect health outcomes, including hypertension and CVD. This review explored how social determinants of health drive disparities in hypertension and related CVD morbidity from a socioecological and life course perspective. We present evidence-based strategies, emphasizing interventions tailored to specific community needs and cross-sector collaboration to address health inequalities rooted in social factors, which are key elements toward achieving the United Nations’ Sustainable Development Goal 3.4 for reducing premature CVD mortality by 30% by 2030.

Blood Pressure Control and Maintenance in a Prospective Cohort of Younger Veterans: Roles of Sex, Race, Ethnicity, and Social Determinants of Health

“…SDoH can influence vulnerability to hypertension, access to treatment, and long-term BP management, 17 particularly among women. 46 Yet, adding the SDI as a proxy of SDoH did not significantly alter associations with BP control.…”

“…44,45 It is also possible that subgroup differences in BP control are due to racial differences in trust, awareness, adherence, and health beliefs, 9 which should also be investigated among younger Veterans, particularly women. 45 SDoH can influence vulnerability to hypertension, access to treatment, and long-term BP management, 17 particularly among women. 46 Yet, adding the SDI as a proxy of SDoH did not significantly alter associations with BP control.…”

“…Social determinants of health (SDoH) – the conditions in which people are born, grow, work, live, and age – contribute to cardiovascular health, risk for hypertension, and CVD outcomes, 17,18 and may underlie intersectional differences in BP control. 19 In the general population, those with a lower income, who live in under resourced neighborhoods, and who have less healthcare access, are less likely to have controlled BP.…”