Disparities in SDOH Highlight Need for Social Intervention in the HF Space

Social determinants of health (SDOH) are unequally distributed among ambulatory individuals who are living with heart failure (HF) when their income level and racial background are considered, according to a new analysis of 1999-2018 National Health and Nutrition Examination Survey data by a team from UT Southwestern Medical Center.

The poster containing this analysis’ findings was presented at the recent American Society for Preventive Cardiology’s Congress on CVD Prevention, held in Arlington, Texas, July 21-23.

“Outcomes in HF patients are modified by their burden of SDOH. There is no data on national prevalence of SDOH among ambulatory HF patients,” the authors wrote. “We aimed to fill this gap by evaluating national prevalence of SDOH among ambulatory HF patients across racial, ethnic, and income groups.”

In addition to income level and race/ethnicity categories, environmental factors and health status were evaluated for their influence as SDOH on HF-related outcomes. The study population comprised 1906 patients representing a weighted 5.25 million individuals in the United States.

An overall 81.4% of the study population (n = 4,275,684) is burdened by at least 2.1 SDOH, according to the investigators, who considered the effects of 5 categories of SDOH in their study: 0, 1, 2, 3, and 4. The fewest patients overall (n = 115,595) were not burdened by any SDOH, while the most in any category was 2.9 million patients (55.0%) reporting 2 SDOH. In addition, 862,500 (16.4%) had a burden of 1 SDOH; 1,268,782 (24.2%) had a burden of 3 SDOH; and 117,461 (2.2%), 4 SDOH.

The mean patient age was 66.3 years, and most patients were male (51.7%), White (71.8%), and had self-reported incomes between 130% and 350% of the federal poverty level (FPL). Of the remaining study population, 14.7% were Black, 8.2% were Hispanic, 5.3% were Asian/Other, 33.7% reported an income below 130% of the FPL, and 20.9% self-reported an income above 350% of the FPL.

Federal poverty level documents - Vitalii Vodolazskyi - stock.adobe.com

Patients reporting incomes below 130% of the FPL were burdened by a higher mean total of SDOH domains compared with the individuals reporting an income between 130% and 350% of the FPL and above 350% of the FPL: 2.5 vs 2.0 vs 1.6, respectively. In addition, Hispanic patients reported the highest mean total of SDOH domains among the race/ethnicity populations, at 2.4, compared with 2.3 among Black patients, 2.2 among Asian/Other patients, and 2.0 among White patients.

Delving deeper for individual SDOH, race/ethnic difference were also seen for the following SDOH (all P < .0001):

• Less than a high school education: Hispanic patients had the highest rate and Asians/Other patients the lowest
• Uninsured status, food insecurity, and household crowding: Hispanic patients had the highest rates for all 3 and non-Hispanic White patients the lowest
• Sleep deprivation (<6 hours/night): Non-Hispanic Black patients had the highest rate and non-Hispanic White patients the lowest

There were also discrepancies seen according to overall income level (all P < .01):

• Patients living below 130% of the FPL had the highest rates of unemployment, less than a high school education, uninsured status, household crowding, sleep deprivation, and physical inactivity
• Those living above 350% of the FPL had the lowest rates across all categories; in addition to the above, this includes no routine place of care, food insecurity, and having any disability
• Individuals living between 130% and 350% of the FPL had the highest rate of having any disability

The study investigators underscore the need for future research to focus on social interventions that can aid in modifying the effects of SDOH to improve outcomes among patients living with HF, due to the uneven distribution they saw in their analysis by income and race/ethnicity.

Reference

Patel L, Lokesh N, Rao S, Powell-Wiley T, Sumarsono A. Prevalence of social determinants among US residents with heart failure by race/ethnicity and household income. Presented at: ASPC Congress on CVD Prevention; July 21-23, 2023; Arlington, Texas. Poster 114.