Affiliation:
1. Division of General Internal Medicine Department of Medicine Weill Cornell Medicine New York NY
2. Department of Epidemiology University of Alabama at Birmingham AL
3. Division of Cardiovascular Disease Department of Medicine University of Alabama at Birmingham AL
4. Division of Cardiology Department of Medicine Weill Cornell Medicine New York NY
Abstract
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 (
Re
asons 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.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine
Cited by
46 articles.
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