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Abstract
Objectives The social environment (SE), that is, the social relationships and social context in which groups of people live and interact, is an understudied element of the broader living environment which impacts health. We aim to summarise the available evidence on the associations between SE and cardiometabolic disease (CMD) outcomes.
Design Systematic review and meta-analysis.
Data sources PubMed, Scopus and Web of Science Core Collection were searched from inception to 28 February 2024.
Eligibility criteria We included studies for which determinants were SE factors such as area-level deprivation and social network characteristics and outcomes were type 2 diabetes mellitus and cardiovascular diseases incidence and prevalence.
Data extraction and synthesis Titles and abstracts and full text were screened in duplicate. Data appraisal and extraction were based on the study protocol published in PROSPERO. Methodological quality was assessed with the Newcastle-Ottawa Scale. We synthesised the data through vote counting and meta-analyses.
Results From 10 143 records screened, 281 studies reporting 1108 relevant associations are included in this review. Of the 384 associations included in vote counting, 271 (71%) suggested that a worse SE is associated with a higher risk of CMD. 14 meta-analyses based on 180 associations indicated that worse SE was associated with increased odds of CMD outcomes, with 4 of them being statistically significant. For example, more economic and social disadvantage was associated with higher heart failure risk (OR 1.58, 95% CI 1.08 to 1.61; n=18; I2=95%). With the exception of two meta-analyses for men, meta-analysed sex-specific associations consistently showed results in the same direction as the overall meta-analyses.
Conclusion Worse SE seems to be associated with increased odds of CMD outcomes, although certain SE dimensions are underexplored in relation to CMD.
PROSPERO registration number CRD42021223035.
- hypertension
- epidemiology
- social support
- cardiac epidemiology
- diabetes & endocrinology
- systematic review
Data availability statement
No data are available.
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Data availability statement
No data are available.
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Footnotes
Contributors TCA, JDM and JWJB contributed to the conception and design of the work, to the data curation and interpretation of data for the work. FH contributed to the data curation. LJS contributed to acquisition and data curation. JDM was responsible for the supervision of the work. TCA conducted formal analysis and drafted the work. All author revised the work critically, approved the final version to be published and are accountable for the work. TCA had full access to all of the data in the study, takes responsibility for the integrity of the data and the accuracy of the data analysis and is the guarantor for this work. TCA is the corresponding author and attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.
Funding This work was supported by EXPOSOME-NL (NWO grant number 024.004.017) and EXPANSE (grant agreement number 874627). EXPOSOME-NL is funded through the Gravitation program of the Dutch Ministry of Education, Culture and Science and the Netherlands Organisation for Scientific Research. EXPANSE received funding from the European Union’s Horizon 2020 research and innovation program.
Disclaimer The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.
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