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The Impact of Socioeconomic Status on Cardiovascular Disease in Older Adults

   

Added on  2020-04-13

23 Pages4540 Words370 Views
Running head: CARDIOVASCULAR DISEASE AND SOCIAL DETERMINANTS 1Cardiovascular Disease and Social DeterminantsNameInstitution

CARDIOVASCULAR DISEASE AND SOCIAL DETERMINANTS 2The Impacts of the Social Determinants of Health on Cardiovascular Disease in OlderAdultsNearly six percent of Canadians were living with cardiovascular disease (CVD) in 2015;a disease which has a mortality rate of 194.7 deaths per 100,000 (Public Health Agency ofCanada, 2017b). Older adults are one of many vulnerable populations in Canada and there are avariety of factors that make them more vulnerable. This paper will explore how socialdeterminants of health (SDOH), specifically socioeconomic status, affects Canadian andinternational multicultural older adult populations with (CVD), include a SDOH model, followedby public health implications that arise as a result of this issue. We will examine why thesesocioeconomic status may affect this vulnerable population and explore information about CVD.For the purposes of this research, older adults are defined as individuals between the agesof 55 and 79. According to Raphael (2016), there are many factors that make senior populationsmore vulnerable or susceptible to higher mortality rates; those including, but are not limited toSDOH such as personal health practices/coping, education, socioeconomic status (SES), gender,and social support systems. When examining the rates of CVD in older adults a comparison willbe made between those of low and high SES. SES will be measured using household income and

CARDIOVASCULAR DISEASE AND SOCIAL DETERMINANTS 3level of education. The writers of this paper believe that older adults that have a lower level ofeducation will have a higher rate of CVD disease due to diminished access or knowledge tosupport and foundations to live or obtain a better quality of lifestyle. The writers also believe thatalong with a lower level of education would contribute to a lower level of income, thus puttingolder adults in a position to not obtain a healthier lifestyle and higher quality of living. Cardiovascular diseases affect the heart and blood vessels and includes coronary heartdisease, cerebrovascular disease, peripheral arterial disease, rheumatic heart disease, congenitalheart disease, deep vein thrombosis and pulmonary embolism (World Health Organization,2017). CVD is a rampant problem for developing nations and is the number one cause of deathworldwide (World Health Organization, 2017). According to the Canadian Chronic DiseaseSurveillance System (CCDSS) incident rates of heart attacks in the Canadian population for agegroups, 50 - 64 and 65-79 are 2.38% and 5.55%, respectively (Public Health Agency of Canada,2017c). This is much higher than age groups 35 - 49, who were 0.61% of the population thatexperience heart attacks (Public Health Agency of Canada, 2017c). In the United States, 69.1%of men and 67.9% of women aged 60 - 79 suffer from some form of CVD (American HeartAssociation, 2016). Diseases of the heart are the lead cause of death for American women over65 years old (American Heart Association, 2016). CVD is commonly diagnosed by a physician in regular or emergency room visits. Data isthen collected through a variety of sampling methods. Specifically, the CCDSS collects databased on health insurance registry databases that are linked to physician billing and hospital

CARDIOVASCULAR DISEASE AND SOCIAL DETERMINANTS 4databases (Public Health Agency of Canada, 2017a). Through this collection technique, errorsfrom self-reporting are avoided. Another common information data base is the CanadianCommunity Health Survey (CCHS). A survey is provided to a cross-section of the country whothen are responsible for self-reporting (Statistics Canada, 2016). When self-reporting is used forcollecting information there is always a chance that respondents will be intentionally dishonestor misunderstand a question and provide the wrong answer. SES and education are SDOH that are the strongest predictors to affect CVD (Joffres etal., 2013; Winkleby et al., 1992). SES reflects spending ability, housing, diet, and medical carebased on income, whereas education reflects skills for social, psychological, and economicresources (Winkleby et al., 1992). A healthy diet is essential for the prevention of CVD yet income can be a stumbling block asmuch of heart disease medication costs are not covered under Medicare (Gucciardi et al., 2009).Those with low income tend to lack insurance coverage that covers expensive medications suchas those for CVD, which are among the most expensive within Canada (Booth et al., 2012;Campbell et al., 2012). Booth et al. (2012) found an increase in diabetes related mortality ratesbetween those of high and low SES especially in those over the age of 65. Woodward et al.(2015) revealed that CVD is associated with lower SES. A community-based study from Turkeyrevealed that unhealthy diet was associated with lower SES (OR = 3.31) and lower education(OR=4.48) (Simsek et al., 2013).

CARDIOVASCULAR DISEASE AND SOCIAL DETERMINANTS 5A lack of education can have profound effects in those with CVD. In developing countries, thereis often a gap in hypertension treatment for seniors due to lack of knowledge of whathypertension is and preventative signs (Maurer & Ramos, 2015). Maurer & Ramos (2015) revealthat low-cost treatment options for hypertension exist and could increase awareness in seniors.Seniors of higher SES are associated with higher physical activity, greater nutritional habits andlower risk of smoking compared to those of lower SES (Campbell et al., 2012). This means thatthose of low SES are associated with increased use of healthcare services that have little impacton poorer health outcomes and mortality (Campbell et al., 2012).It's important to assess how determinants are measured. The studies referenced in this paperdirectly evaluated income, education and CVD data utilizing census reports, self-reporting dataand medical records.SES was measured using household income and level of education, any additional informationon education, income, and occupation was ascertained through questionnaires. For example, onestudy measured income using the "median household income level of an individual’sneighborhood of residence on 1, April, 2002 from the 2001 Canadian Census. Neighborhoodswere defined using small geographic units (dissemination areas) from Statistics Canada" (Boothet al., 2012).Woodward et al. (2015) measured education by using self-reported data, falling into one of threegroups. Group one had no completed education or completed only primary school. Group two

CARDIOVASCULAR DISEASE AND SOCIAL DETERMINANTS 6composed of people who completed secondary school; and lastly group three completed tertiaryeducation (university or college).Booth et al. (2012) recorded "baseline CVD, acute myocardial infarction, and stroke, based onrelevant diagnostic codes from hospital discharge records. Co-morbidity was captured usingdiagnostic codes listed in hospital records and physicians’ service claims from the year prior tobaseline to create distinct case-mix categories based on the Johns Hopkins Adjusted ClinicalGroups case-mix system."If blood pressure and cholesterol levels were used to determine CVD risk, they were obtainedusing standard protocols as in Woodward et al. (2015) and Winkleby et al., (1992).Specific Canadian DataThe CCHS is a cross-sectional study in Canada that measures rates of different healthoutcomes in the country. The most recent complete survey data is from 2014. Based on thesurvey design, the most efficient way to access the rates of CVD was by studying those who self-reported having heart disease. Data was collected for those with heart disease and was thencompared to level of education and to person income. Only the data for those aged 55 to 79 wasanalyzed. When studying the rates of heart disease in both older adult males and females it wasnoted that the highest rates were in those that had completed post-secondary education followedsecondly by those who had not completed secondary education (Statistics Canada, 2016). It islikely that there are confounding factors that create the high rates of heart disease in those with

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