The study, co-authored by Deeb Salem, MD, Senior Vice President, Academic Integration at Tufts Medicine and Sheldon M. Wolff Professor at Tufts University School of Medicine, underscores the need to integrate social determinants into cardiovascular care.
In a comprehensive systematic review of 29 studies published between 2015 and 2025, researchers found that socioeconomic disadvantage—including lower income, limited education and neighborhood deprivation—is consistently associated with worse outcomes in adults with established CVD. Across diverse populations and health systems, patients facing socioeconomic challenges experienced significantly higher mortality rates, with hazard ratios ranging from 1.20 to 2.23, as well as increased hospitalizations and readmissions.
Notably, the findings show that these disparities persist even after accounting for traditional clinical and behavioral risk factors, suggesting that social determinants of health independently influence disease progression and recovery. In other words, factors tied to where a person lives—even their ZIP code—can meaningfully influence cardiovascular outcomes. In some cases, the impact is especially pronounced—for example, individuals living in disadvantaged neighborhoods with valvular heart disease faced a 63% higher risk of 30-day mortality.
"These findings reinforce what many clinicians see every day—that health outcomes are shaped by more than biology alone. To truly improve cardiovascular outcomes, we must integrate social determinants of health into how we assess risk, design treatment plans and deliver care."
Deeb Salem, MD
The study adds to a growing body of evidence calling for healthcare systems to move beyond traditional models and incorporate socioeconomic context into patient care strategies. By doing so, organizations like Tufts Medicine aim to advance more equitable outcomes and better support patients across the full spectrum of their health needs.
This research highlights an important opportunity for innovation in cardiovascular care—one that aligns clinical excellence with a deeper understanding of the communities patients call home.
Learn how Tufts Medicine is advancing heart care through research that addresses both medical and social factors to improve outcomes for every patient.
