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A Toolkit to Facilitate the Selection and Measurement of Health Equity Indicators for Cardiovascular Disease
TOOLS FOR PUBLIC HEALTH PRACTICE — Volume 21 — October 10, 2024
PEER REVIEWED
In the first phase, 1,485 records were identified through a database search; of these, 685 were excluded based on relevance of title and abstract. Of the 800 records screened, 758 were excluded for lacking these criteria: Study location: US; Study dates: 2011 through 2016; Language: English; Article type: Peer-reviewed nonclinical studies; Main health outcome variable or risk factor is related to CVD; Identifies a disparity in CVD outcomes among study groups that have been socially marginalized. Of the 42 full-text articles assessed for eligibility, 7 were excluded for the following reasons: Too clinical, Not original research, or Did not identify a disparity in CVD outcomes among groups that have been socially marginalized. Thirty-five articles were included from first phase.
Figure 1.
Process for conducting the literature scan for development of the Health Equity Indicators for Cardiovascular Disease Toolkit. Abbreviation: CVD, cardiovascular disease.
Along the lefthand side of this figure is an arrow pointing straight up, representing the following socioecological levels, from the bottom to the top: individual, interpersonal, organizational, community, and systems. Running along the bottom of the figure is another arrow, labeled Life course. It points from left to right and is marked from left to right with the following life stages: in utero, infancy, childhood, and adulthood. These 2 arrows frame a large circle with multiple layers and components. The components of the outer layer are genderism, sexism, and heterosexism; racism; and classism. The next layer is policy, which applies to the entire circle. The third layer is health care access; neighborhood characteristics; and socioeconomic factors. The core of the circle is labeled Inequities. A large arrow cuts from left to right through the center of the circle and is labeled psychosocial pathways. This large arrow ends in a separate circle labeled Cardiovascular health and well-being.
Figure 2.
Conceptual framework for the Health Equity Indicators for Cardiovascular Disease Toolkit shows how 8 focus areas influence inequities in cardiovascular disease prevention, care, and management.
This figure consists of 7 columns, each headed by a focus area: genderism, sexism, and heterosexism; health care access; neighborhood characteristics; policy; psychosocial pathways; racism; and socioeconomic factors. Each column consists of a list of health equity indicators. The following indicators are listed for genderism, sexism, and heterosexism: Gender discrimination, Gender income gap, and LGBTQIA+ discrimination. The indicators for health care access are Health care affordability, Health care availability, Health care effectiveness and quality, Health literacy, and Medically underserved areas. The indicators for neighborhood characteristics are Air and water quality, Civic participation, Community food environment, Community safety, Green space, Housing, Incarceration, Liquor store density, Physical activity environment, Poverty, Public assistance, Social cohesion, Social environment, Transit and transportation, and Rurality. The indicators for policy are Living wage policies, Spending per capita (health care, education, parks, greenspace), Sick leave policies, Smoke-free policies, and Social determinants of health measures in electronic health records. For psychosocial pathways, indicators are Access to mental health care, Adverse childhood experiences, Mental health disorders, Sleep health, Social support, Stigma, and Stress. For racism, indicators are Immigration status, Race-consciousness, Racial income gap, Racial residential segregation, Racial and ethnic discrimination and trauma, and Redlining. For socioeconomic factors, indicators are Education, Employment status, Food insecurity, Housing insecurity, and Income.
Figure 3.
List of health equities indicators (HEIs), by focus area, in the Health Equity Indicators for Cardiovascular Disease Toolkit. The list of HEIs was confirmed by a literature review and consultation with subject matter experts. Abbreviation: LGBTQIA+, lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other sexual orientation and gender identity populations.
The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions.