Socioeconomic Status and Cardiovascular Disease

Exposure:: socioeconomic_status
Outcome:: cardiovascular_disease
Evidence:: strong
Version:: 1.0.0

social-determinantscardiovascularclassic

Background

Socioeconomic status (SES) is one of the most robust predictors of cardiovascular disease (CVD) across populations and settings. Lower SES is associated with higher CVD incidence and mortality, and this relationship persists after adjustment for conventional risk factors — suggesting both direct pathways (e.g., material deprivation, chronic stress) and indirect pathways through behavioral intermediaries.

This DAG represents a *domain-level* causal structure intended as a starting point for study-specific derivation. Researchers should add design-specific nodes (selection, measurement, timing) when deriving a study-specific DAG.

The relationship operates through multiple pathways including differential access to healthcare, health behaviors, and chronic psychosocial stress.

DAG

Open in dagitty.net ↗

dag { socioeconomic_status [exposure] cardiovascular_disease [outcome] socioeconomic_status -> healthcare_access socioeconomic_status -> health_behaviors socioeconomic_status -> psychosocial_stress healthcare_access -> cardiovascular_disease health_behaviors -> cardiovascular_disease psychosocial_stress -> cardiovascular_disease socioeconomic_status -> cardiovascular_disease age -> socioeconomic_status age -> cardiovascular_disease sex -> socioeconomic_status sex -> cardiovascular_disease }

Notes

`health_behaviors` aggregates smoking, diet, physical activity
`psychosocial_stress` includes chronic stress and allostatic load
Direct path `ses → cvd` represents residual direct effect
Race/ethnicity, diet, and healthcare access variants are intentionally simplified for this domain-level DAG

References

Marmot 2004 - Social gradient in health PubMed
Havranek et al. 2015 - Social determinants of CVD DOI
Galea 2013 — consequentialist epidemiology framing DOI
Krieger — ecosocial theory and SES-CVD DOI