PDF(Pubmed)
Abstract：
The importance of social drivers of health (SDOH) in the occurrence, detection, treatment, and outcome of atrial fibrillation (AF) has attracted increasing attention. Addressing SDOH factors may suggest opportunities to prevent AF and its complications. We aimed to conduct a structured narrative review and summarize current knowledge on the association between race and ethnicity, SDOH, including rural vs. urban habitation, education, income, and neighbourhood, and the risk of AF, its management, and complications. We identified 537 references in PubMed and 473 references in Embase. After removal of duplicates, we screened the abstracts of 975 references, resulting in 113 references that were examined for eligibility. Subsequently, 34 references were excluded leaving 79 references for the review. Evidence of a social gradient in AF incidence and prevelance were conflicting. However, we found substantial evidence indicating social inequities in the detection of AF, access to treatment, and outcomes such as healthcare utilization, bleeding, heart failure, stroke, dementia, work disability, and death. Inequities are reported across various health care systems and constitute a global problem affecting several continents, although data from Africa and South America are lacking. Given the documented social inequities in AF detection, management, and outcomes, there is an urgent need for healthcare systems, policymakers, and society to identify and implement effective interventions that can reduce inequities and improve outcomes in individuals with AF.
摘要：
社会健康驱动因素(SDOH)在发生中的重要性，检测,治疗,心房颤动（AF）的转归越来越受到关注。解决SDOH因素可能提示预防AF及其并发症的机会。我们的目标是进行结构化的叙事回顾，并总结当前关于种族和民族之间关联的知识，SDOH,包括农村与城市居住,教育,收入,和邻里,和房颤的风险，其管理,和并发症。我们确定了PubMed中的537个参考文献和Embase中的473个参考文献。删除重复项后，我们筛选了975篇参考文献的摘要，导致113个参考文献被审查为合格。随后，排除了34个参考文献，留下了79个参考文献供审查。房颤发病率和患病率的社会梯度证据相互矛盾。然而,我们发现了大量证据表明房颤检测中的社会不平等，获得治疗,以及医疗保健利用等结果，出血,心力衰竭,中风,痴呆症,工作残疾,和死亡。据报道，各种医疗保健系统存在不平等现象，构成影响几大洲的全球问题，尽管缺乏来自非洲和南美的数据。鉴于房颤检测中记录的社会不平等现象，管理,和结果，迫切需要医疗保健系统，政策制定者，和社会来确定和实施有效的干预措施，可以减少不平等和改善个人房颤的结果。
