OBJECTIVES: This study compared the relationships of social determinants with cardiometabolic risk in different socioeconomic contexts: sociopolitically unstable Venezuela (VE) and stable Czechia (CZ). DESIGN: cross-sectional analysis involving two population-based studies. SETTING: Brno, Czechia and 23 cities of Venezuela. PARTICIPANTS: 25-64 years old subjects from CZ (2013-2014, n=1579, 56% females) and VE (2014-2017, n=1652, 70% females). MAIN OUTCOME MEASURES: The composite cardiometabolic risk score (CMRS) (scaled 0-8) was calculated using eight biomarkers (body mass index, waist circumference, blood glucose, systolic and diastolic blood pressure, total and high-density lipoprotein-cholesterol, triglycerides). Social characteristics included education in both countries, income in CZ and a composite measure of social position (SP) in VE. Sex stratified ordinal regression examined the social gradient in having less favourable CMRS. RESULTS: In CZ, men and women with low education and women with low income had higher odds of higher CMRS compared with those with high education and income with OR 1.45 (95% CI 1.01 to 2.21), 2.29 (95% CI 1.62 to 3.24) and 1.69 (95% CI 1.23 to 2.35). In VE, women with low education and low SP had higher odds to have higher CMRS OR 1.47 (95% CI 1.09 to 1.97) and 1.51 (95% CI 1.16 to 1.97), while men with low education and low SP had lower odds to have higher CMRS OR 0.64 (95% CI 0.41 to 1.00) and 0.61 (95% CI 0.40 to 0.97), compared with those with high education and high SP. Independently of age, sex and socioeconomic characteristics, Venezuelans had higher odds to have higher CMRS than Czechs (OR 2.70; 95% CI 2.37 to 3.08). CONCLUSIONS: The results suggest that the associations of socioeconomic status indices and cardiometabolic risk differed between CZ and VE, likely reflecting differences in the social environment among countries. Further research is needed to confirm and quantify these differences.

Department of Cardiovascular Medicine Mayo Clinic Rochester New York USA

Department of Epidemiology and Public Health University College London London UK

Departments of Global Health and Population and Epidemiology Harvard University T H Chan School of Public Health Boston Massachusetts USA

Foundation for Clinic Public Health and Epidemiology Research of Venezuela Caracas Venezuela

International Clinical Research Centre St Anne's University Hospital Brno Czech Republic

RECETOX Faculty of Science Masaryk University Kotlarska 2 Brno Czech Republic

The Marie Josée and Henry R Kravis Center for Cardiovascular Health at Mount Sinai Heart and Division of Endocrinology Diabetes and Bone Disease Icahn School of Medicine at Mount Sinai New York New York USA

See more in PubMed

Marmot M, Bell R. Social determinants and non-communicable diseases: time for integrated action. BMJ 2019;364:l251. 10.1136/bmj.l251 PubMed DOI PMC

Marmot M, Allen JJ. Social determinants of health equity. Am J Public Health 2014;104 Suppl 4(Suppl 4):S517–9. 10.2105/AJPH.2014.302200 PubMed DOI PMC

Pampel FC, Krueger PM, Denney JT. Socioeconomic disparities in health behaviors. Annu Rev Sociol 2010;36:349–70. 10.1146/annurev.soc.012809.102529 PubMed DOI PMC

O’Neil A, Scovelle AJ, Milner AJ, et al. . Gender/sex as a social determinant of cardiovascular risk. Circulation 2018;137:854–64. 10.1161/CIRCULATIONAHA.117.028595 PubMed DOI

Powell-Wiley TM, Baumer Y, Baah FO, et al. . Social determinants of cardiovascular disease. Circ Res 2022;130:782–99. 10.1161/CIRCRESAHA.121.319811 PubMed DOI PMC

Khaing W, Vallibhakara SA, Attia J, et al. . Effects of education and income on cardiovascular outcomes: a systematic review and meta-analysis. Eur J Prev Cardiol 2017;24:1032–42. 10.1177/2047487317705916 PubMed DOI

Fitzová H, Žídek L. Impact of trade on economic growth in the czech and slovak republics. E&S 2015;8:36–50. 10.14254/2071-789X.2015/8-2/4 DOI

Vincens N, Emmelin M, Stafström M. Social capital, income inequality and the social gradient in self-rated health in latin america: a fixed effects analysis. Soc Sci Med 2018;196:115–22. 10.1016/j.socscimed.2017.11.025 PubMed DOI

Fraser B. Data reveal state of venezuelan health system. Lancet 2017;389. 10.1016/S0140-6736(17)31435-6 PubMed DOI

González-Rivas JP, Mechanick JI, Ponte C, et al. . Impact of the complex humanitarian crisis on the epidemiology of the cardiometabolic risk factors in venezuela. Clin Investig Arterioscler 2022;34:97–104. 10.1016/j.arteri.2021.04.002 PubMed DOI

Movsisyan NK, Vinciguerra M, Lopez-Jimenez F, et al. . Kardiovize brno 2030, a prospective cardiovascular health study in central Europe: methods, baseline findings and future directions. Eur J Prev Cardiol 2018;25:54–64. 10.1177/2047487317726623 PubMed DOI

Nieto-Martínez R, Marulanda MI, Ugel E, et al. . Venezuelan study of cardio-metabolic health (EVESCAM): general description and sampling. Med Interna 2015;31:102–11.

Nieto-Martínez R, Inés Marulanda M, González-Rivas JP, et al. . Cardio-metabolic health venezuelan study (EVESCAM): design and implementation. Invest Clin 2017;58:56–69. PubMed

Harris PA, Taylor R, Thielke R, et al. . Research electronic data capture (redcap) -- a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009;42:377–81. 10.1016/j.jbi.2008.08.010 PubMed DOI PMC

Duong MT, Bingham BA, Aldana PC, et al. . Variation in the calculation of allostatic load score: 21 examples from NHANES. J Racial Ethn Health Disparities 2017;4:455–61. 10.1007/s40615-016-0246-8 PubMed DOI PMC

Friel S, Marmot MG. Action on the social determinants of health and health inequities goes global. Annu Rev Public Health 2011;32:225–36. 10.1146/annurev-publhealth-031210-101220 PubMed DOI

Petrovic D, Pivin E, Ponte B, et al. . Sociodemographic, behavioral and genetic determinants of allostatic load in a swiss population-based study. Psychoneuroendocrinology 2016;67:76–85. 10.1016/j.psyneuen.2016.02.003 PubMed DOI

Dinsa GD, Goryakin Y, Fumagalli E, et al. . Obesity and socioeconomic status in developing countries: a systematic review. Obes Rev 2012;13:1067–79. 10.1111/j.1467-789X.2012.01017.x PubMed DOI PMC

Adedoyin RA, Afolabi A, Adegoke OO, et al. . Relationship between socioeconomic status and metabolic syndrome among nigerian adults. Diabetes Metab Syndr 2013;7:91–4. 10.1016/j.dsx.2013.02.014 PubMed DOI

Jiwani SS, Carrillo-Larco RM, Hernández-Vásquez A, et al. . In latin america and the caribbean: a cross-sectional series study; 1998. Available: www.thelancet.com/ PubMed PMC

Gronner MF, Bosi PL, Carvalho AM, et al. . Prevalence of metabolic syndrome and its association with educational inequalities among brazilian adults: a population-based study. Braz J Med Biol Res 2011;44:713–9. 10.1590/s0100-879x2011007500087 PubMed DOI

Mazariegos M, Auchincloss AH, Braverman-Bronstein A, et al. . Educational inequalities in obesity: a multilevel analysis of survey data from cities in Latin America. Public Health Nutr 2021;25:1–9. 10.1017/S1368980021002457 PubMed DOI PMC

Mechanick JI, Farkouh ME, Newman JD, et al. . Cardiometabolic-based chronic disease, adiposity and dysglycemia drivers: JACC state-of-the-art review. J Am Coll Cardiol 2020;75:525–38. 10.1016/j.jacc.2019.11.044 PubMed DOI PMC

Williams PRD, Dotson GS, Maier A. Cumulative risk assessment (Cra): transforming the way we assess health risks. Environ Sci Technol 2012;46:10868–74. 10.1021/es3025353 PubMed DOI PMC

Yen IH, Syme SL. The social environment and health: a discussion of the epidemiologic literature. Annu Rev Public Health 1999;20:287–308. 10.1146/annurev.publhealth.20.1.287 PubMed DOI

World Health Organizationfor the Eastern Mediterranean . Regional office. social determinants of health in countries in conflict: a perspective from the eastern mediterranean region. 2008: 96.

Guidi J, Lucente M, Sonino N, et al. . Allostatic load and its impact on health: a systematic review. Psychother Psychosom 2021;90:11–27. 10.1159/000510696 PubMed DOI

Mattei J, Demissie S, Falcon LM, et al. . Allostatic load is associated with chronic conditions in the boston puerto rican health study. Soc Sci Med 2010;70:1988–96. 10.1016/j.socscimed.2010.02.024 PubMed DOI PMC

López-Cepero A, McClain AC, Rosal MC, et al. . Examination of the allostatic load construct and its longitudinal association with health outcomes in the Boston Puerto Rican health study. Psychosom Med 2022;84:104–15. 10.1097/PSY.0000000000001013 PubMed DOI PMC

Gustafsson PE, Janlert U, Theorell T, et al. . Socioeconomic status over the life course and allostatic load in adulthood: results from the Northern Swedish cohort. J Epidemiol Community Health 2011;65:986–92. 10.1136/jech.2010.108332 PubMed DOI

Kim GR, Jee SH, Pikhart H. Role of allostatic load and health behaviours in explaining socioeconomic disparities in mortality: a structural equation modelling approach. J Epidemiol Community Health 2018;72:545–51. 10.1136/jech-2017-209131 PubMed DOI

Mechanick JI, Marchetti AE, Apovian C, et al. . Diabetes-specific nutrition algorithm: a transcultural program to optimize diabetes and prediabetes care. Curr Diab Rep 2012;12:180–94. 10.1007/s11892-012-0253-z PubMed DOI PMC