Scoping Report and Interactive Evidence Map on Studies of Environmental Exposures, Psychosocial Stressors, and Cardiovascular Diseases in Disproportionally Impacted Communities

Background and Aim Worldwide, cardiovascular disease (CVD) is the leading cause of death, with two-thirds of CVD- related deaths occurring in low- and middle-income countries. In addition to socioeconomic status (SES), CVD rates vary by race, ethnicity, and place. Environmental Health disparities (EHD) are predominately caused by systematic racism leading to higher exposure to environmental toxins, higher indicators of psychosocial stress, and social inequities. Our goal is to inform the scientific community and disproportionally affected populations (DAP) on the scope of the literature on CVD EHD and identify research gaps. Methods To target relevant epidemiological studies and reviews, we searched PubMed using a broad range of terms for DAPs, environmental exposures, psychosocial stressors, and CVD outcomes. DAPs included racial, ethnic, and sexual minority groups and people with lower SES status or living in rural areas. Using exclusion/inclusion criteria, we screened the studies to determine relevancy. Included studies were reviewed and characterized by specific populations, environmental exposures, psychosocial stressors, and CVD outcomes. We visualized and explored the findings using six interactive evidence maps in Tableau. Results We identified >1,400 relevant primary studies on CVD and psychosocial stressors or environmental exposures; >800 were conducted in DAP. The most studied racial/ethnic population was Black people (>300), and there were very few studies on sexual minorities (<10). Most DAP studies reported on personal behaviors (>60%), air pollution (~35%), SES indicators, and hypertension (~55%) for all DAP; however, some patterns differ according to the DAP. About 20% of studies reported allostatic load, and 7% evaluated racism and CVD. A research gap is the evaluation of environmental-psychosocial stressors interactions and CVD. Conclusions Our evidence map is a resource for DAP and scientific communities to explore the state of the science on CVD EHD and can be used to develop health equity solutions. Keywords: EHD, CVD