Abstract P210: The Social Distribution Of Ideal Cardiovascular Health: A Global Systematic Review

Abstract

Introduction: Numerous studies have examined the social determinants of ideal cardiovascular health (ICVH) around the world, but no work has summarized evidence to date. This study aimed to systematically review findings on the social distribution of ICVH globally, and to compare trends in high-income countries (HICs) vs. low/middle-income countries (LMICs). Methods: In November 2019, we systematically searched PubMed, Embase, and LILACS for observational studies published after the American Heart Association (AHA) defined ICVH as a combination of health factors and behaviors in 2010. Search terms included ICVH/Life’s Simple 7 and a pre-defined set of social determinants of health (i.e., education, income/wealth, socioeconomic status (SES), employment, occupation, and race/ethnicity). Each abstract was reviewed by two independent researchers. Studies were included if associations between a composite measure of ICVH and a social determinant of health was quantified using statistical methods. We evaluated risk of bias using an adapted version of the Newcastle-Ottawa Quality Assessment Scale. Overall findings and comparisons between HICs and LMICs (defined by World Bank guidelines) were summarized narratively. Results: A total of 33 studies met inclusion criteria. Only 8 studies were from LMICs (n=4 from China), while 25 were from HICs (n=19 from the US). The most commonly assessed social determinants were education (n=18) and income/wealth (n=17). In both HICs and LMICs, few studies examined occupation or area-level measures, like rurality/urbanicity. Most studies were cross-sectional (n=27). Two thirds of studies and had a moderate (n=14, 43%) or high (n=8, 24%) risk of bias, but no systematic differences were noted by country setting. Nearly half of studies used composite ICVH measures that were of moderate or poor quality (i.e., based on only self-reported data and/or unvalidated instruments), and only 15% of studies (n=5) assessed each ICVH component using the exact criteria defined by the AHA. Despite substantial heterogeneity in how ICVH measures were derived and analyzed (e.g., as a binary, categorical, or count variable), fairly consistent associations were observed between higher levels of ICVH and higher social status (higher education, income/wealth, racial/ethnic majority status) across both HICs and LMICs. Studies of occupation (n=6, all from HICs) and area-level measures (n=4, 3 from LMICs) were less conclusive. Conclusion: Associations between higher social status and ICVH were noted in both HICs and LMICs, but most evidence was based on correlational data from cross-sectional studies in the US, primarily in relation to education and income. Important gaps in the literature include studies from LMICs, longitudinal designs to improve causal inference, and investigations of occupation, rurality/urbanicity, and race/ethnicity in non-US settings.