The dynamic nature of the socioeconomic determinants of cardiovascular health: A narrative review

Despite decades of social epidemiologic research, health inequities remain pervasive and ubiquitous in Canada and elsewhere. One reason may be our use of socioeconomic measurement, which have often relied on single point-in-time exposures.To explore the extent to which researchers have incorporated dynamic socioeconomic measurement into cardiovascular health outcome evaluations, we performed a narrative review. We estimated the prevalence of socioeconomic longitudinal cardiovascular research studies that identified socioeconomic exposures at two or more points in time between the years of 2019 and 2023. We defined cardiovascular outcome studies as those that examined coronary artery disease, myocardial infarction, acute coronary syndrome, stroke, heart failure, cardiac arrythmias, cardiac death, cardiometabolic factors, transient ischemic attacks, peripheral artery disease, or hypertension. Socioeconomic exposures included individual income, neighborhood income, intergenerational social mobility, education, occupation, insurance status, and economic security. 7% of socioeconomic cardiovascular outcome studies have measured socioeconomic status at two or more points in time throughout the follow-up period. Hypothesized mechanisms by which dynamic socioeconomic measures impacted outcome focused on social mobility, accumulation, and critical period theories. Insights, implications, and future directions are discussed, in which we highlight ways in which postal code data, can be better utilized methodologically as a dynamic socioeconomic measure. Future research must incorporate dynamic socioeconomic measurement to better inform root-causes, interventions, and health system designs if health equity is to be improved.