Social Determinants of Kidney and Cardiovascular Outcomes

In 2005, the World Health Organization (WHO) created the inaugural Social Determinants of Health (SDOH) Commission to recognize how social and physical environments impact health for all populations. In doing so, they created an impetus for policy-making and governing bodies to improve the underlying social conditions underpinning health for all, particularly for the most disadvantaged populations. Over the past decade, these efforts have coincided with growing evidence from high-middle- and low-income nations, that adverse structural/social determinants of health (SDOH) are fundamentally linked to advanced cardiovascular disease (CVD) and kidney disease, stark disparities in disease prevalence, and high, avoidable health care costs. In 2023, the American Heart Association coined cardiovascular kidney metabolic syndrome (CKM) -a condition recognizing the inextricable link between metabolic syndrome, diabetes, CKD, CVD and the social determinants of health (SDOH). In the following review, we first summarize the evidence regarding SDOH and kidney and cardiovascular outcomes within U.S. contexts, highlighting epidemiologic studies demonstrating the association between adverse SDOH and advanced CKM syndrome. We then describe how governance and policies may undergird SDOH including community-level (e.g. the natural and built environment, commercial determinants of health) and individual-level factors (e.g. economic conditions, education) which influence cardiovascular and kidney health. In this section, we provide examples of salutary policies and actions which can optimize health outcomes by addressing key contributors to health inequality (e.g. unequal adverse health exposures, limited opportunity to access health-promoting resources). We also overview postulated mechanisms through which SDOH impact CKM outcomes, such as glucocorticoid resistance, chronic sympathetic activation & pro-Inflammatory transcription, weathering, and premature aging. Through sustained investments and policy actions that reduce health-related vulnerabilities and promote equitable access to opportunities, conditions, and resources essential for health, we can fulfill a shared vision of achieving optimal CKM health across populations.