Social Determinants of Health Vital for Assessing Heart Disease Risk

An individual’s social determinants of health can provide valuable information about a person’s potential risk of heart disease, but these non-clinical factors are often overlooked, according to new research from the American College of Cardiology (ACC).

The organization conducted two studies that examined how social determinants like food security, financial stability, and healthcare access can play a critical role in heart disease development.

In one of the studies, researchers examined data from nearly 400,000 US adults in the Behavioral Risk Factor Surveillance System that was collected in 2017. The Behavioral Risk Factor Surveillance System is a phone-based survey that has been conducted annually for over 35 years.

Researchers observed that nearly one in ten of the survey respondents reported having at least one form of heart disease. The team then examined how people’s perceptions of their levels of food, housing, and financial security related to their likelihood of having different forms of heart disease, including heart attack, stroke, coronary artery disease and congestive heart disease.

After adjusting for demographic factors, socioeconomic status, and known cardiovascular risk factors, the team found that several social determinants were linked to an increased risk of heart disease.

Food and housing insecurity increased the odds of heart disease by more than 50 percent, while a lack of healthcare access increased the odds by 47 percent. People with a high level of financial insecurity were more than twice as likely to have heart disease as those who considered themselves financially secure.

Researchers noted that there are several possible reasons for these associations: Food insecurity could make it difficult to maintain a heart-healthy diet, while financial or housing insecurity can lead to stress that may contribute to heart disease. A lack of access to healthcare can cause people to delay screening or care until a cardiovascular issue is more advanced.

“We are very focused on addressing certain cardiovascular risk factors, but we forget about factors such as food, housing and financial security that often play a major role in the development of cardiovascular disease," said Tarang Parekh, MBBS, an assistant researcher in the Department of Health Administration and Policy at George Mason University and lead author of one of the studies.

"We are not investing enough to address these issues. We must start addressing patients' problems from a broader perspective in order to better reduce the toll of cardiovascular diseases."

The group noted many health systems have recognized these issues, and have reached out beyond their clinic walls to address individuals’ social determinants of health.

"Recently, healthcare systems have been considering adding questions relevant to social determinants of health to electronic health records, which would be a really good step," Parekh said.

"In addition, some physicians have started asking questions about the challenges patients may be facing in terms of food, housing and finances and collaborating with non-profit and community organizations to address these issues in addition to other cardiovascular risk factors a patient has."

In future work, researchers will evaluate the timing of heart disease development to further highlight its relationship to social and financial factors.

In a separate study, researchers focused on modeling tools doctors commonly use to measure patients’ cardiovascular risk. The results showed that current risk prediction models, which don’t incorporate data on income, education level, housing status, or food insecurity, likely underestimate the cardiovascular risk faced by minority patients and those with low income.

Since doctors use risk scores to inform treatment plans, this oversight could result in greater health disparities.

"If we systematically underpredict risk, we will systematically undertreat," said Gmerice Hammond, MD, cardiology fellow at Washington University School of Medicine and the study's lead author. "Our study is the first to show that if you bring a robust panel of social determinant factors into the risk models, you may actually be able to improve clinical risk prediction."