Untangling the Complex Multidimensionality of the Social Determinants of Cardiovascular Health: A systematic review.

BACKGROUND: The cardiovascular literature is limited by the lack of consensus on what are the best metrics for reporting social determinants of health (SDH)/social deprivation and if they should be reported as a single metric or separately by their domains.

METHODS: A systematic review of the literature on cardiovascular surgeries and procedures was conducted, identifying articles from January 1st 2010 to December 31st , 2023 that studied the relationship between health outcomes post cardiovascular procedures and/or surgeries and SDH/social deprivation. The cardiovascular procedures/surgeries of interest were coronary and valve surgeries and procedures including Coronary Artery Bypass Grafting (CABG), percutaneous coronary intervention (PCI), valve replacement/repair and transcatheter aortic valve intervention (TAVI).

RESULTS: After screening 638 articles, we identified 47 papers that met our inclusion and exclusion criteria. The most common procedure evaluated was CABG and PCI - 46 of the studies focused on these 2 procedures. Almost all the articles reported a different metric for SDH/social deprivation (41 different metrics); despite this, all the metrics showed a consistent relationship with worse outcomes associated with greater degrees of SDH/deprivation. Only 9 reported on the individual domains of SDH/social deprivation; 3 studies showed a discordant relationship.

CONCLUSION: Although our systematic review identified numerous articles evaluating the relationship between SDH/social deprivation in cardiovascular disease, there was substantial heterogeneity in which metric was used and how it was reported. This reinforces the need for standards as to what are the best metrics for SDH/social deprivation as well as best practice for reporting.