The SDOH Factor That Impacts Heart Disease

There is a direct relationship between socioeconomic status and a person’s susceptibility to heart attacks and strokes, according to a new study.

For the large-scale prospective cohort study, published in The Lancet: Global Health, SFU Health Sciences professor Scott Lear and colleagues examined the relationship between education, household wealth, cardiovascular disease, and mortality to assess which marker is the stronger predictor of outcomes, and determined whether any differences in cardiovascular disease by socioeconomic status parallel differences in risk factor levels or differences in management.

Lear and his fellow researchers recruited adults aged between aged 35 years and 70 years from 367 urban and 302 rural communities in 20 countries. They then collected data on families and households in two questionnaires, and data on cardiovascular risk factors in a third questionnaire, which was supplemented with physical examination. Socioeconomic status was assessed using education and a household wealth index. Education was categorized as no or primary school education only, secondary school education, or higher education, defined as completion of trade school, college, or university. Household wealth, calculated at the household level and with household data, was defined by an index on the basis of ownership of assets and housing characteristics.

“Education is a risk factor for heart disease and more important than wealth,” says Lear, who holds the Pfizer/Heart & Stroke Foundation Chair in Cardiovascular Prevention Research at St. Paul's Hospital and is the principal investigator of the Prospective Urban Rural Epidemiology (PURE) study site in Vancouver.

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Primary outcomes were major cardiovascular disease (a composite of cardiovascular deaths, strokes, myocardial infarction, and heart failure), cardiovascular mortality, and all-cause mortality. Information on specific events was obtained from participants or their family, according to the study.

The researchers found that education is one of the strongest determinants of heart disease and that this may in part be due to less access to care in those with a lower education.

“The difference in access to care is more pronounced in settings where the education inequality is greatest,” says Lear. “Education is an easy factor to measure and should be conducted as part of a health assessment, included in a patient’s record. Since education is modifiable-unlike age or sex-then we should be looking at education as something that can be targeted by public health and health promotion interventions. In terms of health, education is no different from cholesterol or blood pressure.”

Part of the increased risk for heart disease due to education is a result of less access to healthcare, Lear reiterates.

“Public health and health promotion interventions should be designed to improve education, especially in vulnerable populations,” he says. “This can start with targeting retention in high schools. Healthcare organizations should be mindful of ensuring access to healthcare in vulnerable populations.”