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Cited by 1,408Health disparities and outcomesCardiovascular Health and Risk FactorsPublic Health and Social Inequalities

Socioeconomic Status and Cardiovascular Outcomes: Challenges and Interventions

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Schultz, William M., Kelli, Heval M., Lisko, John C., Varghese, Tina, Shen, Jia, Sandesara, Pratik, Quyyumi, Arshed A., Taylor, Herman A. +6 more·2018·Circulation
DOI 10.1161/circulationaha.117.029652PMC PMC5958918
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Abstract

Socioeconomic status (SES) has a measurable and significant effect on cardiovascular health. Biological, behavioral, and psychosocial risk factors prevalent in disadvantaged individuals accentuate the link between SES and cardiovascular disease (CVD). Four measures have been consistently associated with CVD in high-income countries: income level, educational attainment, employment status, and neighborhood socioeconomic factors. In addition, disparities based on sex have been shown in several studies. Interventions targeting patients with low SES have predominantly focused on modification of traditional CVD risk factors. Promising approaches are emerging that can be implemented on an individual, community, or population basis to reduce disparities in outcomes. Structured physical activity has demonstrated effectiveness in low-SES populations, and geomapping may be used to identify targets for large-scale programs. Task shifting, the redistribution of healthcare management from physician to nonphysician providers in an effort to improve access to health care, may have a role in select areas. Integration of SES into the traditional CVD risk prediction models may allow improved management of individuals with high risk, but cultural and regional differences in SES make generalized implementation challenging. Future research is required to better understand the underlying mechanisms of CVD risk that affect individuals of low SES and to determine effective interventions for patients with high risk. We review the current state of knowledge on the impact of SES on the incidence, treatment, and outcomes of CVD in high-income societies and suggest future research directions aimed at the elimination of these adverse factors, and the integration of measures of SES into the customization of cardiovascular treatment.

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Authors
Schultz, W. M., Kelli, H. M., Lisko, J. C., Varghese, T., Shen, J., Sandesara, P., Quyyumi, A. A., Taylor, H. A., Gulati, M., Harold, J. G., Mieres, J. H., Ferdinand, K. C., Mensah, G. A., & Sperling, L. S.
Affiliations
  • Department of Medicine (W.M.S., J.C.L., T.V.)
  • Emory University (US)
  • Morehouse School of Medicine (US)
  • University of Arizona (US)
  • Cedars-Sinai Medical Center (US)
  • Northwell Health (US)
  • Tulane University (US)
  • National Institutes of Health (US)
ORCID
Venue
Circulation
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2018-05-15
Volume
137
Issue
20
Pages
2166-2178
ISSN
  • 0009-7322 (ISSN-L)
  • 1524-4539
DOI
10.1161/circulationaha.117.029652
PMC
PMC5958918
OpenAlex
W2889465019
Cited by
1,408
References
11
Citations by year
2026: 182 · 2025: 267 · 2024: 232 · 2023: 219 · 2022: 190 · 2021: 169 · 2020: 89 · 2019: 51 · 2018: 6 · 2017: 1
FWCI
12.98
Type
journal article
Language
en
Open access
Locations
  • Circulation (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
Funders
  • National Institutes of Health (5r01ns064162-04, Z99 HL999999)
  • National Institute on Aging (RF1AG051633)
  • National Heart, Lung, and Blood Institute (P01HL101398, P20HL113451, P01HL086773, R61HL138657, U10HL110302, R01HL095479, R01HL089650, T32HL130025)
  • National Institute of Diabetes and Digestive and Kidney Diseases (DP3DK094346, P30DK111024)
  • National Institute of Neurological Disorders and Stroke (R01-NS064162)
Topics
  • Social Sciences › Health › Health disparities and outcomes
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
  • Social Sciences › Health › Public Health and Social Inequalities
Keywords
socioeconomic status, cardiovascular disease, cardiovascular risk factors, health disparities, income, educational attainment, employment status, neighborhood socioeconomic factors, sex differences, physical activity, task shifting, cardiovascular risk prediction models, cardiovascular outcomes, cardiovascular disease treatment
MeSH terms
Cardiovascular Diseases, Educational Status, Humans, Income, Risk Factors, Social Class, Health Behavior, Exercise

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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