High social risk has a negative effect on cardiovascular health status in underserved populations, according to study findings published in the International Journal of Cardiology.
Investigators sought to evaluate the effect of social risk on the cardiovascular health (CVH) in participants in an underserved, rural population. They initiated a population-based longitudinal study in the villages of Atahualpa, El Tambo, and Prosperidad, Ecuador, that included 443 older adults identified by a door-to-door survey (2012-2019 in Atahualpa, 2019-2020 in the other villages) and invited to participate in the study. Villagers (59% women) shared ethnicity (Amerindian), low levels of economic status, diet, living conditions (40% poor sleepers), and education (78% primary school only). There is 1 public health center in Atahualpa. The other 2 villages use a public hospital in a neighboring small city. The study included patients who were aged at least 60 years (mean 67±7 years) and had received baseline CVH metric and social determinant of health (SDH) assessments. These patients also had CVH metric determinations at the end of the study period.
Baseline social risk determinations were made by means of SDH components in the Gijon’s Social-Familial Evaluation Scale (SFES), along with clinical interviews and procedures to determine CVH status in the Life’s Simple 7 construct (includes 4 health behaviors: smoking, body mass index, physical activity, and diet; and 3 health factors: blood pressure, fasting glucose, and total cholesterol blood levels). The Gijon’s SFES is a field instrument rating family situation, economic status, housing conditions, social relationships, and support networks with 5 questions, each weighted 1 to 5, where a higher score indicates greater social risk.
The mean Gijon’s SFES score was 9.8±2.7 points, at baseline. The mean number of ideal CVH metrics was 3.1±1.3. After a mean follow-up of 7.31±3.26 years, the mean number of ideal CVH metrics decreased to 2.6±1.2 (β, -0.467; 95% CI, -0.588 to -0.346).
The researchers noted the following changes in the 7 CVH metrics at baseline vs follow-up, respectively:
- Smoking status, 97% vs 95%
- Body mass index, 36% vs 34%
- Physical activity, 44% vs 28%
- Diet, 22% vs 15%
- Blood pressure, 21% vs 18%
- Fasting glucose, 27% vs 16%
- Total cholesterol blood levels, 60% vs 53%
Study limitations include selection bias and that less than 15% of the population with vascular risk factors received proper therapy during the study years.
“…this study indicates a deleterious effect of high social risk on CVH status,” the researchers wrote. “Understanding the problem of high social risk in rural settings is important for public health planning and the implementation of cost-effective tailored preventive policies targeting SDH to improve the CVH status.”
Del Brutto OH, Mera RM, Rumbea DA, Recalde BY, Sedler MJ. Detrimental effect of high social risk on the cardiovascular health status of community-dwelling older adults living in rural settings. A population-based, longitudinal prospective study. Int J Cardiol. Published online December 26, 2022. doi:10.1016/j.ijcard.2022.12.044