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Canadian Journal of Cardiology

Cardiovascular Health Issues in Inner City Populations

  • Dhruv Nayyar
    Affiliations
    Centre for Research on Inner City Health, The Keenan Research Centre at the Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
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  • Stephen W. Hwang
    Correspondence
    Corresponding author: Dr Stephen W. Hwang, Centre for Research on Inner City Health, The Keenan Research Centre at the Li Ka Shing Knowledge Institute, St Michael's Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8, Canada. Tel.: +1-416-864-5991; fax: +1-416-864-5558.
    Affiliations
    Centre for Research on Inner City Health, The Keenan Research Centre at the Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
    Search for articles by this author
Published:April 21, 2015DOI:https://doi.org/10.1016/j.cjca.2015.04.011

      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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