The following are key points to remember from a 2024 ACC/AHA clinical document on key data elements and definitions for social determinants of health (SDOH) in cardiology:

1. Many clinicians may consider SDOH (e.g., economic stability, neighborhood and the built environment, social and community context, or access to and quality of health care and education) to be the realm of policymakers and social scientists, but there is increasing recognition that SDOH have a major impact on patients’ health outcomes and quality of life across the life course.
2. Clarity around the definitions of these SDOH is an important component to advancing clinical care and research focused on reducing health disparities and optimizing outcomes for all individuals throughout the lifespan.
3. This document provides standard definitions for SDOH relevant to cardiovascular disease. After an environmental scan of extensive existing data standards, the writing group generated consensus about the data elements and definitions most relevant to cardiovascular care.
4. SDOH can be characterized at the individual level, the interpersonal level, or the community or societal level. These contribute to a comprehensive understanding of social influences on health outcomes.
5. Individual-level SDOH consists of the domains:
   • Race, ethnicity, sex, sexual orientation, gender identity, immigration status, and acculturation;
   • Language and literacy;
   • Educational attainment, income, and employment;
   • Health literacy, broadband access, and digital literacy;
   • Dietary quality, and food access and security; and
   • Health insurance.
6. Interpersonal SDOH includes the domains of:
   • Social connection and network;
   • Interpersonal discrimination;
   • Disparate health care quality; and
   • Psychosocial stress.
7. Community-level SDOH consists of the domains:
   • Racial segregation;
   • Housing quality;
   • Civic participation and voting rights;
   • Access to and availability of health care services;
   • Community-level education and employment;
   • Community-level rates of incarceration and violence;
   • Transportation access and walkability;
   • Research infrastructure and access to clinical trials; and
   • Area-level composite indices.
8. SDOH at the individual, interpersonal, and community levels may overlap and are not mutually exclusive. Implementing these data standards will require that data attributes such as data formats, data types, target values, and mapping to standardized code sets be developed.
9. Strategies to integrate SDOH in electronic health records and data repositories will be necessary to ensure that these data standards can be deployed to achieve more equitable health and optimal health outcomes.
10. Finally, additional studies are indicated to develop a greater understanding of the interrelationship among SDOH and the mediating effects of one domain upon another (e.g., racism may result in poverty, which in turn results in poor health care access and low health literacy).

Clinical Topics: Cardiovascular Care Team, Prevention

Keywords: Cardiology, Common Data Elements, Quality of Health Care, Social Determinants of Health

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