New 2024 ACC/AHA Key Data Elements and Definitions for Social Determinants of Health (SDOH) in Cardiology aim to provide clarity around SDOH definitions with the goal of optimizing clinical care and research addressing health disparities.

According to the Writing Committee, led by Chair Alanna A. Morris, MD, MSc, FACC, and Vice Chair Frederick A. Masoudi, MD, MSPH, MACC, "SDOH affect a wide range of health risks, health outcomes, and quality-of-life indicators and contribute to health disparities; therefore, it is increasingly important that SDOH be prospectively incorporated into clinical practice and research."

The Committee conducted an extensive environmental scan of existing SDOH models like the World Health Organization's Conceptual SDOH Framework, the Rural Community Health and Well-Being Framework, the National Institute on Minority Health and Health Disparities Research Framework, etc. They also reviewed existing data standards from the Health Level 7 Gravity Project, the National Institutes of Health, the Agency for Healthcare Research and Quality, and others to determine the data elements and definitions of greatest relevance to cardiovascular care.

The document divides the SDOH data elements into three primary levels addressing individual, interpersonal and community domains. At the individual level, the document outlines six domains consisting of 1) race, ethnicity, sex, sexual orientation, gender identity, immigration status, and acculturation; 2) educational attainment, income and employment; 3) language and literacy; 4) health literacy, broadband access or digital divide, and digital health literacy; 5) dietary quality and food insecurity; and 6) health insurance status.

On the interpersonal level, SDOH elements consist of four domains, including 1) social connection or network; 2) interpersonal discrimination; 3) disparate health care quality; and 4) psychosocial stress. At the community or society level, SDOH domains include indices of racial and ethnic segregation; housing quality and instability; civic participation and voting rights; environmental conditions; access to and availability of health care services; community-level education, income and employment; community-level rates of incarceration, crime and violence; and research infrastructure and access to clinical trials.

According to the authors, the development of these SDOH standards is a "necessary early step in the more complex process of advancing health equity and optimizing health outcomes for all individuals." However, the next challenge will be implementation. "Mechanisms to enhance the inclusion of consistently defined data elements that best reflect individuals and their lived environment in [electronic health records (EHRs)], clinical research, and health data systems will be necessary to support action," they write.

"Despite a growing appreciation of the impact of social factors on cardiovascular health, these data are not widely available, particularly on the individual level, to support initiatives and research intended to improve health outcomes for those at social disadvantage," said Masoudi. "The first step to developing widespread actionable data is to create a common vocabulary for social determinants. Armed with these standards, EHR vendors and organizations that provide health care should collaborate to integrate key data standards into clinical workflow to facilitate consistent documentation of these factors, which would permit a deep, meaningful understanding of social factors both within and among organizations."

The data standards were developed by the ACC/American Heart Association Joint Committee on Clinical Data Standards and are endorsed by the American Society for Preventive Cardiology, Heart Failure Society of America, Heart Rhythm Make Well Known Foundation, Preventive Cardiovascular Nurses Association, and Society of Behavioral Medicine Affirmation of Value by the Society for Cardiovascular Angiography and Interventions. NCDR currently collects demographic elements that can in some cases be used as proxies for SDOH. The key constructs of SDOH and corresponding data elements, as presented in this clinical document, provide a roadmap for how registries can incorporate more SDOH in the future to inform clinical practice and research. Learn more about NCDR at CVQuality.ACC.org.