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Canadian Journal of Cardiology

Interventions Targeted to Address Social Determinants of Health in Ischemic Heart Disease: A Sex- and Gender-Oriented Scoping Review

      Abstract

      The burden of ischemic heart disease (IHD) is a major health problem worldwide. The detrimental effect of gendered (ie, unevenly distributed between female and male) socioeconomic determinants of health (SDOH) on outcomes has been demonstrated, more so in female individuals. Therefore, addressing SDOH is a priority for the care implementation of patients with IHD. We conducted a scoping review to identify the types of SDOH-tailored interventions tested in randomised controlled trials (RCTs) among IHD patients, and whether the reporting of findings was sex-unbiased. We identified 8 SDOH domains: education, physical environment, health care system, economic stability, social support, sexual orientation, culture/language, and systemic racism. A total of 28 RCTs (2 ongoing) were evaluated. Since the 1990s, 26 RCTs have been conducted, mainly in the Middle East and Asia, and addressed only education, physical environment, health care system, and social support. The 77% of studies focused on patient-education interventions, and around 80% on SDOH-based interventions achieved positive effects on a variety of primary outcome(s). Among the limitations of the conducted RCTs, the most relevant were an overall low participation of female and racial/ethnical minority participants, a lack of sex-stratified analyses, and a missing opportunity of tailoring some SDOH interventions relevant for health. The SDOH-tailored interventions tested so far in RCTs, enrolling predominantly male patients and mainly targeting education and health literacy, were effective in improving outcomes among patients with IHD. Future studies should focus on a wider range of SDOH with an adequate representation of female and minority patients who would most benefit from such interventions.

      Résumé

      La cardiopathie ischémique est un problème de santé important à l’échelle mondiale. L’incidence des facteurs socioéconomiques de la santé selon le sexe (c.-à-d. sa répartition inégale entre les femmes et les hommes) sur les résultats de santé a déjà été démontrée, et elle s’avère particulièrement marquée chez les femmes. Il est donc primordial de tenir compte de ces facteurs dans les soins prodigués aux patients atteints d’une cardiopathie ischémique. Nous avons procédé à une revue exploratoire afin de cerner les types d’interventions qui tenaient compte des facteurs socioéconomiques de la santé et qui ont été étudiées lors d’essais contrôlés randomisés (ECR) chez des patients atteints d’une cardiopathie ischémique. Nous avons également cherché à déterminer si les résultats présentaient un biais lié au sexe. Pour ce faire, nous avons classé les facteurs dans huit domaines : éducation, environnement physique, système de soins de santé, stabilité économique, soutien social, orientation sexuelle, culture/langue et racisme systémique. Nous avons évalué un total de 28 ECR (dont deux en cours). Depuis les années 1990, 26 ECR ont été menés, surtout au Moyen-Orient et en Asie, mais ils ne portaient que sur l’éducation, l’environnement physique, le système de soins de santé et le soutien social. De ces essais, 77 % s’attardaient aux interventions axées sur l’éducation des patients, et environ 80 % des interventions axées sur les facteurs socioéconomiques de la santé ont généré des effets positifs sur les divers critères principaux. Parmi les lacunes des ECR réalisés, les plus pertinentes étaient la faible présence générale de sujets de sexe féminin ou issus de minorités raciales/ethniques, un recours insuffisant aux analyses stratifiées selon le sexe et la non-adaptation de certaines interventions axées sur les facteurs socioéconomiques de la santé. Les interventions étudiées à ce jour lors des ECR, auxquels participaient surtout des hommes et qui portaient principalement sur l’éducation et la littératie en santé, ont permis d’améliorer les résultats pour les patients atteints de cardiopathie ischémique. Les essais réalisés ultérieurement devraient porter sur une plus vaste gamme de facteurs socioéconomiques de la santé et donner une plus grande place aux sujets de sexe féminin ou issus de minorités, qui bénéficieraient le plus de telles interventions.

      Graphical abstract

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