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Chapter 107: Social Determinants of Cardiovascular Disease

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If current trends prevail, the prevalence of cardiovascular disease (CVD) in the United States is expected to rise 10% between 2010 and 2030. To what factors can this projected rise in CVD prevalence not be attributed?

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A. An aging populace

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B. An increase in major risk factors (hypertension, lack of physical activity, obesity, and diabetes)

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C. Growing socioeconomic inequality

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D. An increase in immigration from developing countries

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E. Inequalities in the availability of clinical advances made in the diagnosis, treatment, and prevention of CVD

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The answer is D. (Hurst’s The Heart, 14th Edition, Chap. 107) Cardiovascular disease is the number one cause of death around the globe, now accounting for about one in three deaths.1 More than 80% of these CVD deaths take place in low- and middle-income countries.2 Although mortality from CVD in the United States has been declining since the 1970s, heart disease is still the leading cause of death in America as well, accounting for approximately 31.3% of deaths in 2011.3 The US decline in CVD mortality has been attributed to advances in prevention, diagnosis, and treatment. However, if current trends prevail, the prevalence of CVD in the United States is expected to rise 10% between 2010 and 2030.4 This projected rise in CVD prevalence is attributed to a number of factors: an aging populace (option A), an increase in major risk factors (hypertension, lack of physical activity, obesity, and diabetes) (option B), and growing socioeconomic inequality (option C) that accentuate the deleterious social determinants of health. Further, the clinical advances made in the diagnosis, treatment, and prevention of CVD have not been equally available to everyone in our society (option E).5 The United States is one of the richest nations in the world and spends more per capita on health care than any other nation, and yet America has one of the shortest life expectancies at birth of any industrialized nation, ranking 27th out of 34 Organization for Economic Cooperation and Development countries.6

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A 30-year-old indigenous woman presents to her local community clinic after reporting that she has been feeling unwell. Her history reveals she has type 2 diabetes and a history of alcoholism, and she suffers from major depression. Which of the following is true about this patient’s circumstances?

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A. Health disparities are likely contributors to this patient’s poor health

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B. Health inequalities are likely contributors to this patient’s poor health

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C. Health outcome disparities result from the effects of institutional ...

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