Understanding the Dynamics of Social Determinants in Health Disparity, and Their Impact on Cardiovascular Diseases



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Traditional efforts to improve health in the United States have been driven by focusing on the health care system. However, these efforts require broader approaches that also address social, economic, and environmental factors that influence health. Cardiovascular diseases remain the leading cause of death in the United States. Although CVD disparities are shaped by differences in risk factors across racial and ethnic groups, non-traditional risk factors such as housing and food insecurities remain important social determinants of health (SDOH). While the recent trend in CVD mortality has declined, the prevalence of CVD is expected to rise by 10% in 2030. With this current trajectory, chapter 1 of this dissertation is focused on identifying predictors of SDOH by reviewing and summarizing literature that examined the association of housing and food insecurity with cardiovascular disease. Chapter 2 builds on the findings from study-1 through identified literature gap in potential predictors of housing and food insecurities, retrospectively examining how demographics, socioeconomic, and healthcare characteristics differ by available food environment and the likelihood of CVD mortality with poor food environment. Chapter 3 focuses on addressing this unique challenge of capturing SDOH by conducting a natural experiment using the Difference-in-Difference methodology and examining whether the broad-based health delivery system and payment reforms can incentivize social risk factor diagnosis in hospital settings among adults hospitalized with CVD.



Cardiovascular disease, Food environment, Food insecurity, Housing instability, Social determinants of health, Social factors