Data on 10 social determinants of health (SDOH) were analyzed to determine their distribution among low-income patients hospitalized for heart failure (HF) at a safety-net hospital.
More emphasis needs to be placed on finding solutions to the social determinants of health (SDOH) that hinder care access for low-income patients living with heart failure (HF), according to research presented1 at last month’s American Society for Preventive Cardiology’s Congress on CVD Prevention, held in Arlington, Texas.
The patients (N = 118) in this study had been hospitalized for HF exacerbations at Parkland Memorial Hospital, a safety-net hospital in Dallas. Most (61.9%) of these participants were non-Hispanic Black; 20.3% were Hispanic; 15.3%, non-Hispanic White; and 2.5%, non-Hispanic other. Their mean (SD) age was 53.4 (10.5) years, 75.4% were male patients, and the median annual income was $13,200. HF with reduced ejection fraction (HFrEF) was prominent, with mean left ventricular rejection fraction (LVEF) being 30% (14%). A diagnosis of HFrEF is typically given when LVEF is 40% or below.2
“Association between SDOH and HF is well established,” the study authors wrote. “Distribution of SDOH amongst patients hospitalized for HF is unknown, especially at safety-net hospitals.”
They investigated these 10 SDOH domains: housing instability, financial health, food security, cost-related medication nonadherence, transportation barriers, social support, interpersonal violence, discrimination, health literacy, and health numeracy. Data on substance use disorder were also included where available. To be included in this analysis, all of the patients had to speak English or Spanish and they could not be in police custody or jail.
Overall, approximately half of the patients in this analysis (47.5%) reported at least 1 form of substance use disorder, and 63.1% reported living below 130% of the federal poverty limit. The top 3 most common SDOH were discrimination (87.3%), poor financial health (78.0%), and transportation barriers (67.8%).
Drilling down even further, the following were reported:
Food security was classified into 3 categories—high, low, and very low—with most respondents (44.9%) reporting they had a high level of food security. Just as many (43.2%) reported a very low level of food security, and 11.9% reported a low level of food insecurity.
When prevalence was analyzed by race, 5 areas of distinction emerged, highlighting differences:
Overall, most patients reported 3 or 7 SDOH (16.1% each) as affecting their HF care, followed by 15.25% reporting 6 SDOH; 14.41%, 5 SDOH; 12.71%, 4SDOH; 7.63%, 2 SDOH; 6.78%, 8 SDOH; 5.08%, 1 SDOH; 3.39%, 9 SDOH; and 0.85%, 10 SDOH.
“There is a substantial SDOH burden in safety-net, inpatient populations,” the study authors concluded. “Next steps should include targeting SDOH for their effects on HF outcomes.”
References
1. Lokesh N, Nagori A, Keshvani N, Ambarish P, Sumarsono. Social determinants in a low-income population with heart failure (HF). Presented at: ASPC Congress on CVD Prevention; July 21-23, 2023; Arlington, Texas. Poster 143.
2. What is ejection fraction ? (HFrEF and HFpEF). Heartfailurematters.org. Accessed August 14, 2023. https://www.heartfailurematters.org/understanding-heart-failure/what-is-ejection-fraction-hfref-and-hfpef/
3. Numeracy. CDC. Updated March 18, 2022. Accessed August 14, 2023. https://www.cdc.gov/healthliteracy/researchevaluate/numeracy.html#:~:text=In%20the%20context%20of%20health,about%20screening%20and%20treatment%20options
CMS' 340B Repayment Proposal May Harm Vulnerable Hospitals, Reward Those With Higher Revenues
April 26th 2024The 340B hospitals not receiving an offsetting lump-sum payment from CMS following 2018-2022 cuts later ruled unlawful are disproportionately rural, publicly owned, and nonacademic, according to a new study.
Read More
Examining Low-Value Cancer Care Trends Amidst the COVID-19 Pandemic
April 25th 2024On this episode of Managed Care Cast, we're talking with the authors of a study published in the April 2024 issue of The American Journal of Managed Care® about their findings on the rates of low-value cancer care services throughout the COVID-19 pandemic.
Listen
Empowering Community Health Through Wellness and Faith
April 23rd 2024To help celebrate and recognize National Minority Health Month, we are bringing you a special month-long podcast series with our Strategic Alliance Partner, UPMC Health Plan. In the third episode, Camille Clarke-Smith, EdD, MS, CHES, CPT, discusses approaching community health holistically through spiritual and community engagement.
Listen
Mental Health Diagnoses, Care Challenges Rise Among US Youth, Report Finds
April 26th 2024While behavioral health care utilization has been rising, the treatment landscape has been worsening. New findings show that 20% of youths did not receive any form of treatment within 3 months of their initial behavioral health diagnosis.
Read More