CVD Environmental Health Disparities Tool: systematic evidence mapping of psychosocial stressors, environmental exposures, and cardiovascular diseases to inform disparities research and action.

backgroundGlobally, cardiovascular disease (CVD) is the leading cause of death and disproportionately affects the poor and certain races and ethnic groups.

objectivesIdentify and map current knowledge on contributors, i.e., psychosocial stressors (PSS) and environmental exposures, to these disparities. PSS may work though the same mechanistic pathways and could also increase the susceptibility of an individual to environmental exposures.

methodsWe conducted systematic evidence mapping constructed from searches performed in PubMed. Study data was extracted for environmental exposures, PSS, CVD-related outcomes, disproportionately affected populations (DAPs), and other characteristics. Finally, we selected four exemplars two environmental exposures (noise, heat/cold), one PSS (discrimination), and one CVD (allostatic load) with varying databases to conduct a more in-depth review and illustrate the utility of the tool.

resultsWe created the CVD Environmental Health Disparities Tool using data from over 8,000 relevant reviews and primary studies identified from over 53,000 unique references. The publicly available tool consists of six interactive systematic evidence maps (SEMs); three are specific for DAPs and three for all populations. Collectively, these SEMs include 35 environmental exposures, 13 PSS, and > 30 CVD outcomes in 9 populations. Each SEM allows users to visualize and filter the evidence by the extracted data, evaluate patterns, and identify research gaps and identify recommendations to meet those gaps. We found few studies on minority sexual orientation populations, household products, and green spaces. To illustrate the utility of the tool, for each exemplar, we identified recommendations for primary studies, e.g., the need to evaluate the interactions between PSS and environmental exposures (all exemplars), conduct studies in DAPs (e.g., noise, heat/cold for racial and ethnic groups), and determine which exposure-outcome pairs warranted a systemic review (e.g., discrimination and several CVDs) or intervention (e.g., allostatic load could be used to evaluate intervention efficacy).

conclusionOur comprehensive systematic evidence mapping and tool is unique because it provides a comprehensive characterization of studies of environmental exposures and PSS across all CVD outcomes. It is a resource that can be leveraged to inform effective research leading to action and provide knowledge to affected communities and community-based organizations.