Social Determinants

Various structural barriers have historically predisposed socially disadvantaged populations to increased risk of cardiovascular disease (CVD). Sociodemographic disparities in cardiovascular care and outcomes are pervasive, and affect marginalized population groups adversely, and disproportionately. To a large extent, these disparities are explained by social determinants of health (SDOH)—the conditions in which individuals live and work, procreate and grow old, form social networks, and seek and provide help. Despite their well-documented role in determining overall health and wellbeing, SDOH remain grossly under-utilized in contemporary cardiovascular medicine. In particular, SDOH provide unique opportunities to tailor medical care to the individual patient, and are documented to improve outcomes when appropriately integrated into clinical care. However, current precision medicine approaches rarely incorporate SDOH into personalized decision management tools, which potentially restricts the benefits of precision health on both an individual and population level. In this chapter, we present an exhaustive framework to (i) highlight the association between SDOH and CVD (ii) identify high-risk populations that may benefit greatly from individually tailored cardiovascular care, and (iii) advance the development, and refinement of SDOH-informed precision care models for CVD, with implications for population cardiovascular health. The proposed framework is discussed in the context of historical inequities in health and health care in the US.