Abstract

Despite ongoing public health initiatives, disparities in cardiovascular disease (CVD) mortality between rural and urban populations persist. This systematic review aimed to clarify how social determinants of health (SDoH) influence CVD outcomes among rural communities. Following PRISMA guidelines, Scopus, PubMed, and Web of Science were searched for studies published from January 2016 to August 2025 examining the effects of SDoH on CVD outcomes in rural populations. Additional studies were identified through Google Scholar and reference list screening. Two reviewers independently assessed titles, abstracts, and full texts, resolving disagreements through discussion. Risk of bias was evaluated using the Cochrane ROBINS-I tool. The search yielded 223 articles, with 6 further studies identified through other sources. After screening and eligibility assessment, 11 studies met the inclusion criteria. The findings highlighted that rural–urban disparities in CVD incidence, mortality, and clinical outcomes stem from complex interactions between SDoH, including socioeconomic disadvantage, limited healthcare access, lower educational attainment, and environmental constraints, and cardiovascular health. Of the included studies, six exhibited low risk of bias, four showed moderate risk, and one demonstrated serious risk. SDoH substantially shape cardiovascular morbidity, mortality, and overall outcomes. Rural populations remain disproportionately affected due to structural, geographic, and socioeconomic barriers. Addressing these disparities requires coordinated policy actions, investment in rural health infrastructure, improved access to preventive services, and culturally appropriate strategies that strengthen community resilience and reduce long-standing inequities.

Key words: Atrial fibrillation, cardiovascular diseases, social and community context, social determinants of health, rural population, systematic review