Cardiovascular health disparities

Abstract

Prior to this study, cardiovascular health disparities were observed in the Netherlands, particularly among younger patients from ethnic minority and low socioeconomic groups. Yet, these disparities are not reflected in Dutch prevention guidelines, which rely on traditional risk factors without adjustments for ethnicity or socioeconomic status.

This thesis aimed to describe, analyse, and understand such disparities using routine healthcare data, and to explore whether prevention guidelines and clinical practice require adaptation.

In Part 1 of the thesis, the ELAN data-warehouse was introduced and validated as a resource for cardiovascular research. ELAN integrates data from general practitioners, hospitals, mental health, and national registries, covering 2.6 million individuals in South Holland province. It provides a unique opportunity to study minority subgroups. In Part 2, health disparities were investigated. Mortality from cardiovascular disease was disproportionately high among Surinamese, Antillean, and low socioeconomic groups. The SCORE2 risk model underpredicted risk in these populations and disparities persisted even after diagnosis of cardiovascular disease. This thesis revealed that large ethnic and socioeconomic disparities in cardiovascular health exist in the Netherlands. Current guidelines do not account for this, necessitating structural changes in guidelines (both on prevention and treatment) to promote health equity for all.