Social Determinants of Health Linked to Worse Outcomes in Hypertrophic Cardiomyopathy

Social determinants of health (SDOH) were found to be associated with increased risk of heart failure (HF) and ventricular arrhythmias (VA) in patients with hypertrophic cardiomyopathy (HCM), according to a new study published in JAMA Cardiology.¹

Numerous studies have linked worsening outcomes in cardiovascular health and diseases with patients experiencing suboptimal SDOH, which have been recognized as nonmedical drivers of health outcomes.² However, there is minimal research investigating the influence SDOH have on cardiovascular outcomes in patients with genetically predisposed conditions, like HCM, defined by left ventricular (LV) hypertrophy, diastolic dysfunction, and myocardial fibrosis. Adverse events and clinical presentation vary due to the heterogeneity of the disease, which is only partially explained by patient covariate data, leading researchers to investigate if SDOH are independently associated. Patients facing challenges in these areas often incur difficulties accessing health care services like preventative care, diagnostic testing, and timely interventions—potentially exacerbating preexisting comorbidities.¹

SDOH can be broken into 5 categories: economic stability, education, health care access and quality, neighborhood environment, and social and community context.² In this study, 2 metrics of SDOH were used to define patients: median household income and social deprivation index (SDI). Patients were grouped by area-based income. The lowest income group was defined by a household income of less than $80,000, the middle-income group was defined by a household income ranging from $80,000 to $100,000, and the highest income group was defined by a household income greater than $100,000.

Patient SDI was based on 7 components, assigned a value ranging from 0 to 100, and categorized into 3 groups. The most deprived group was defined by patients living in an area with an SDI greater than 45, the middle group defined by an SDI of 20 to 45, and the least deprived group defined by an SDI less than 20.

Patient data were obtained from the Sarcomeric Human Cardiomyopathy Registry. Patients who met the criteria had an LV wall thickness of 5 mm or more, were 18 years or older, and had available SDOH data. There were 4431 patients included in the study with an average age of HCM diagnosis of 51.3 years. Of them, 1862 (42.0%) were female. The median area-based household income was $80,000, and the median SDI was 25.

Compared with the highest income group, patients in the lowest income group had a younger mean (SD) age at diagnosis (49.2 [15.2] years vs 50.7 [15.5] years; P = .009), a higher percentage of New York Heart Association class 3 or 4 symptoms (33.7% vs 17.0%; P < .001), and a higher percentage with overweight or obesity (body mass index ≥ 25; 85.1% vs 76.1%; P < .001). Comparatively, patients in the most deprived group experienced similar risks as those in the lowest income group compared with the least deprived group.

Furthermore, patients residing in low-income and the most deprived areas had a greater mean LV wall thickness and higher LV outflow tract compared with patients in high-income and less deprived areas. Those in the lowest income area also had higher HRs for HF compared with the highest and middle-income areas (2.07; 95% CI, 1.77-2.42; P < .001; and 1.42; 95% CI, 1.24-1.62; P < .001), respectively. The HRs in the lowest-income areas were also greater for atrial fibrillation (AF) (1.10; 95% CI, 0.97-1.26; P = .14; and 1.19; 95% CI, 1.04-1.37; P = .01) and VA (1.31, 95% CI, 0.97-1.78; P = .08; and 1.28; 95% CI, 0.95-1.73; P = .09) compared with the highest- and middle-income areas.

HRs for overall composite, HF, AF, and VA outcomes of patients in low-income and most deprived areas were all greater when compared with patients in high-income and least deprived areas.¹

Additionally, patients who self-identified as Black were more likely to live in lower-income and high-SDI areas compared with those who self-identified as Asian or White. Prior research and experts have emphasized the significant impact of SDOH on Black patients, leading to poor health outcomes, especially when it comes to cardiovascular health.³

“This analysis demonstrates that where someone lives may influence clinical outcomes, even in conditions with strong genetic etiologies like HCM, and one’s environment likely contributes to the heterogeneity of disease presentation,” the study authors wrote.

This study has several limitations. Area-based SDOH were measured at the zip code level, which may mask individual-level and neighborhood variation; did not capture temporal or geographic changes; and were limited to US sites, restricting generalizability. Additionally, the use of a single composite SDOH index and adjustment for clinical risk factors such as hypertension and obesity may have underestimated the true impact of SDOH on HCM outcomes.

“Future studies are needed to identify solutions to reduce risk and improve access and care for patients with HCM who experience more adverse SDOH to improve the overall disease trajectory in these patients,” the study authors concluded.

References

1. Hafeez N, Claggett BL, Owens AT, et al. Social determinants of health and clinical outcomes in hypertrophic cardiomyopathy. JAMA Cardiol. Published online January 7, 2026. doi:10.1001/jamacardio.2025.4869

2. McCrear S. Social determinants of health linked to congestive heart failure deaths. AJMC^®. July 21, 2025. Accessed January 7, 2026. https://www.ajmc.com/view/social-determinants-of-health-linked-to-congestive-heart-failure-deaths

3. McCrear S, Melvin Echols M. Social drivers of health can impact regular exercise, increase CVD risk: Melvin Echols, MD. AJMC. August 8, 2025. Accessed January 7, 2026. https://www.ajmc.com/view/social-drivers-of-health-can-impact-regular-exercise-increase-cvd-risk-melvin-echols-md