A framework to integrate social determinants into cardiovascular diseases and diabetes registries

Background

monitoring health inequalities in cardiovascular diseases (CVD) and diabetes mellitus (DM) requires data on social determinants of health (SDH) shaping risk, care access and outcomes. However, these variables are inconsistently collected across registries and health information systems (HIS), limiting comparability and routine data use for equity-oriented action. Within JACARDI, we developed an implementation framework to systematically integrate SDH variables into CVD and DM monitoring systems.

Methods

aligned with the WHO SDH conceptual model, the framework supports the integration of SDH variables into CVD and DM registries and HIS. Variables were defined, operationalised and classified by priority (core, recommended or optional), data level and collection feasibility. Implementation is supported by guidance on GDPR, sensitive data restrictions, proxy variables, a checklist and a practical guideline.

Results

The framework provides an SDH variable catalogue structured into structural and intermediate determinants. Structural determinants comprise axes of inequality —age, sex, gender, education, occupation, income, ethnicity, etc.— and contextual determinants, such as socioeconomic context. Intermediate determinants comprise material circumstances —employment, income adequacy and housing conditions—, psychosocial factors, behavioural factors and health system factors. All implementation tools support the practical integration of SDH variables into CVD and DM registries, enabling stratified and intersectional analyses of health inequalities.

Conclusions

Integrating SDH variables into CVD and DM registries can strengthen health inequality monitoring and improve data comparability. This framework provides an operational basis for systematic, feasible and legally adaptable SDH data collection. Its use may support risk stratification, benchmarking, evaluation of equity-oriented interventions and evidence-informed public health decision-making.

Key messages

• Cardiovascular diseases and diabetes mellitus monitoring systems need social determinants of health data to capture inequalities in risk, access to care and outcomes.

• A feasible, legally adaptable framework can support social determinants of health data use for equity-oriented public health action.