Social Determinants of Health and 90‐Day Mortality After Hospitalization for Heart Failure in the REGARDS Study

Background Outcomes following heart failure (HF) hospitalizations are poor, with 90-day mortality rates of 15% to 20%. Although prior studies found associations between individual social determinants of health (SDOH) and post-discharge mortality, less is known about how an individuals' total bu...

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Vydáno v:Journal of the American Heart Association Ročník 9; číslo 9; s. e014836
Hlavní autoři: Sterling, Madeline R., Ringel, Joanna Bryan, Pinheiro, Laura C., Safford, Monika M., Levitan, Emily B., Phillips, Erica, Brown, Todd M., Goyal, Parag
Médium: Journal Article
Jazyk:angličtina
Vydáno: England John Wiley and Sons Inc 05.05.2020
Wiley
Témata:
Age Factors
Aged
cohort study
Female
heart failure
Heart Failure - diagnosis
Heart Failure - mortality
Heart Failure - therapy
Hospitalization
Humans
Male
Medicare
mortality
Original Research
Prospective Studies
Risk Assessment
Risk Factors
Social Determinants of Health
Socioeconomic Factors
Time Factors
United States - epidemiology
United States
mortality
heart failure
social determinants of health
cohort study
ISSN:2047-9980, 2047-9980
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Shrnutí:Background Outcomes following heart failure (HF) hospitalizations are poor, with 90-day mortality rates of 15% to 20%. Although prior studies found associations between individual social determinants of health (SDOH) and post-discharge mortality, less is known about how an individuals' total burden of SDOH affects 90-day mortality. Methods and Results We included participants of the REGARDS (Reasons for Geographic and Racial Differences in Stroke) Study who were Medicare beneficiaries aged ≥65 years discharged alive after an adjudicated HF hospitalization. Guided by the Healthy People 2020 Framework, we examined 9 SDOH. First, we examined age-adjusted associations between each SDOH and 90-day mortality; those associated with 90-day mortality were used to create an SDOH count. Next, we determined the hazard of 90-day mortality by the SDOH count, adjusting for confounders. Over 10 years, 690 participants were hospitalized for HF at 440 unique hospitals in the United States; there were a total of 79 deaths within 90 days. Overall, 28% of participants had 0 SDOH, 39% had 1, and 32% had ≥2. Compared with those with 0, the age-adjusted hazard ratio for 90-day mortality among those with 1 SDOH was 2.89 (95% CI, 1.46-5.72) and was 3.06 (1.51-6.19) among those with ≥2 SDOH. The adjusted hazard ratio was 2.78 (1.37-5.62) and 2.57 (1.19-5.54) for participants with 1 SDOH and ≥2, respectively. Conclusions While having any of the SDOH studied here markedly increased risk of 90-day mortality after an HF hospitalization, a greater burden of SDOH was not associated with significantly greater risk in our population.
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This study was presented at the American Heart Association Quality of Care and Outcomes Research Scientific Sessions Conference, April 5–6, 2019, in Arlington, VA. This study was also presented as a poster at the American Heart Association Scientific Sessions, November 17, 2019, in Philadelphia, PA.
For Sources of Funding and Disclosures, see page 10.
ISSN:2047-9980
2047-9980
DOI:10.1161/JAHA.119.014836