Gender, Marital Status, and Community Determinants of Cardiovascular Risk in South Africa: An Epidemiological and Sociological Analysis

Though social determinants are considered to shape health outcomes, only a few studies have examined how sex, marital status, and community context intersect to influence the risk of cardiovascular diseases (CVDs) in highly unequal societies. This study investigates these dynamics in South Africa using pooled data from seven nationally representative surveys, including the South African Demographic and Health Survey (2003), the National Income Dynamics Study (2008–2017), and the South African National Health and Nutrition Examination Study (2012). Multilevel logistic regression models were used to assess both individual- and community-level predictors of CVD. These findings challenge dominant assumptions of gendered resource theory, particularly the notion that marriage is universally protective. Contrary to expectations, married men exhibited elevated CVD risk, likely reflecting role strains under economic precarity and constrained access to care. This study introduced the Gendered Widowhood Vulnerability Hypothesis, showing that CVD risk among widowed or divorced men is contingent on community-education levels and is significantly higher in moderately educated communities, contexts in which aspirations may outpace opportunities. Higher levels of community education were associated with an increased CVD risk among men, which is consistent with the Community-Level Educational Paradox Hypothesis. This finding complicates the presumed protective role of education and demands reconceptualization of its health impact in resource-constrained settings. By integrating life course, gender, and place-based frameworks, this study advances the sociological understanding of how intersecting social structures produce health disparities. These insights can inform gender-sensitive health strategies targeting structurally marginalized men in unequal political economies.