Abstract
Inner city populations in high-income countries carry a disproportionately high burden
of cardiovascular disease. Although low individual socioeconomic status has long been
associated with higher morbidity and mortality from cardiovascular disease, there
is a growing body of evidence that area-level socioeconomic status may also have a
major effect on cardiovascular outcomes. A lack of supermarkets, limited green space,
and high rates of violent crime in inner city neighbourhoods result in poor dietary
intake and low rates of physical activity among residents. The physical and social
environments of inner city neighbourhoods may also contribute to high rates of comorbid
mental illness in disadvantaged urban populations. Mental illness may lead to the
clustering of cardiovascular risk factors through its impact on health behaviours,
effects of psychiatric medications, and sequelae of substance abuse. Individuals residing
in disadvantaged neighbourhoods experience reduced access to both primary preventive
and acute in-hospital cardiovascular care. This may be driven by financial disincentives
for caring for patients with low socioeconomic status, as well as system capacity
issues in the inner city, and patient-level differences in health-seeking behaviours.
Small-scale studies of interventions to improve individual-level health behaviours
and access to care in the inner city have demonstrated some success in improving cardiovascular
outcomes through the use of mobile clinics, health coaching, and case management approaches.
There is a need for further research into community-wide interventions to improve
the cardiovascular health of inner city populations.
Résumé
Les populations des quartiers défavorisés des pays à revenu élevé portent un fardeau
disproportionnellement élevé de maladies cardiovasculaires. Bien que le faible statut
socioéconomique des individus ait longtemps été associé à une morbidité et une mortalité
plus élevées de maladies cardiovasculaires, il existe de plus en plus de données probantes
établissant que le statut socioéconomique des régions peut également avoir des conséquences
majeures sur les résultats cardiovasculaires. Le manque de supermarchés, les espaces
verts limités et les taux élevés de crimes violents dans les quartiers défavorisés
du centre-ville entraînent un apport alimentaire médiocre et de faibles taux d’activité
physique chez les résidents. Les environnements physiques et sociaux des quartiers
défavorisés du centre-ville peuvent également contribuer à des taux élevés de troubles
mentaux cormorbides dans les populations urbaines désavantagées. Les troubles mentaux
peuvent mener à l’accumulation des facteurs de risque de maladies cardiovasculaires
par ses répercussions sur les comportements en matière de santé, les effets des médicaments
psychotropes et les séquelles de la toxicomanie. Les individus qui résident dans des
quartiers défavorisés subissent une diminution de l’accès aux soins de prévention
primaire et aux soins cardiovasculaires de courte durée dans un hôpital. Les obstacles
financiers peuvent dissuader d’offrir des soins aux patients de statut socioéconomique
faible, ainsi que les questions de capacité du système dans les quartiers pauvres
et les différences concernant la propension des patients à recourir aux soins. Les
études à petite échelle sur les interventions pour améliorer les comportements en
matière de santé sur le plan individuel et l’accès aux soins dans les quartiers pauvres
ont démontré un certain succès dans l’amélioration des résultats cardiovasculaires
par l’utilisation de cliniques mobiles, de l’accompagnement en santé et des approches
de prise en charge coordonnée. D’autres recherches en intervention communautaire sont
nécessaires pour améliorer la santé cardiovasculaire des populations des quartiers
défavorisés du centre-ville.
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Article info
Publication history
Published online: April 21, 2015
Accepted:
April 6,
2015
Received:
February 3,
2015
Footnotes
See page 1135 for disclosure information.
Identification
Copyright
© 2015 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
