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American Heart Association

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Final ID: MDP161

Social Determinants of Health: Impact on Mortality and Care Status for Adults with Congenital Heart Disease

Abstract Body (Do not enter title and authors here): Introduction: Social determinants of health (SDOH) impact health outcomes for adults with congenital heart disease (CHD). We sought to understand how SDOH impacted access to care and mortality in adults with CHD.

Methods: Electronic health records were queried across 13 PCORnet clinical sites to identify adults with CHD (CHI-RON study). Those with moderate or complex CHD lesion types were included in the current analyses. Social deprivation index (SDI), our predictor, was calculated using zip code scores (0-100) and were categorized into quintiles (from least to most deprived). Out of care status was defined as no cardiology visit for >2 years (complex CHD) or 3 years (moderate CHD) as of 2/28/20. Only centers with >90% positive predictive value on care status validation were included in the care status analysis. Mortality was confirmed through the National Death Index. Multivariable logistic regression assessed the association between SDI and outcomes (mortality, care status) with fixed effects for CHD complexity, age, sex, and random effects for sites.

Results: Our cohort included 20495 patients with a median age of 33 years (range: 23-48), 50% with moderate CHD, 50% male, 10.3% non-Hispanic Black, 13.2% Hispanic, and 42% urban. Of 5916 included in the care status analysis, 41.7% were out of care. Higher (worse) SDI scores had greater odds of being out of care, with the greatest risk in the highly (OR 1.3, CI: 1.1-1.6, p< 0.001) and most deprived (OR 1.4, CI: 1.2-1.7, p<0.001) communities. SDI factors most associated with being out of care included regions with lower educational attainment (OR 1.6, CI: 1.4-1.8, p<0.001), lower vehicle (OR 1.5, CI 1.4-1.7, p<0.001) or home (OR 1.7, CI 1.5-2.0, p<0.001) ownership, and higher unemployment (OR 1.8, CI 1.5-2.2, p<0.001). Mortality rate was ~3% (n=618). Factors associated with higher odds of mortality included: living in highly deprived (OR 1.7, CI: 1.3-2.1, p<0.01) or most deprived (OR 1.6, CI: 1.2-2.1, p< 0.01) communities, Black (OR: 1.9; CI: 1.5-2.3, p<0.01) or Hispanic (OR: 1.6; CI: 1.2-2.1, p<0.01) race and ethnicity, and living in rural areas (OR: 2.0; CI 1.5-2.6, p<0.001).

Conclusions: Adults with CHD living in areas with higher SDI scores may be at greater risk for not receiving recommended cardiology care and mortality; Black, Hispanic, and rural ACHD patients may be at higher risk for mortality. Further study is needed to understand how social and systemic drivers intersect with race to impact CHD.
  • Jackson, Jamie  ( Nationwide Childrens Hospital , Columbus , Ohio , United States )
  • Lewis, Matthew  ( Columbia University , Larchmont , New York , United States )
  • Saidi, Arwa  ( University of Florida , Gainesville , Florida , United States )
  • Kanter, Ronald  ( Nickalus Children's Hospital , Miami , Florida , United States )
  • Sandhu, Satinder  ( University of Miami , Miami , Florida , United States )
  • Young, Thomas  ( Ochsner Medical Center , New Orleans , Louisiana , United States )
  • Jacobsen, Roni  ( Childrens Hospital Colorado , Aurora , Colorado , United States )
  • Ruckdeschel, Emily  ( Children's Hospital of Philadelphia , Philadelphia , Pennsylvania , United States )
  • Lubert, Adam  ( Cincinnati Children's Hospital , Cincinnati , Ohio , United States )
  • Singh, Harsimran  ( WEILL CORNELL - NY PRESBYTERIAN , New York , New York , United States )
  • Zaidi, Ali  ( Mount Sinai Heart , New York , New York , United States )
  • Mehta, Rittal  ( Children's National Hospital , Washington DC , District of Columbia , United States )
  • Halpern, Dan  ( NYU LANGONE HEALTH , New York , New York , United States )
  • Leezer, Scott  ( CURA Strategies , Arlington , Virginia , United States )
  • Carton, Thomas  ( Louisiana Public Health Institute , New Orleans , Louisiana , United States )
  • John, Anitha  ( CHILDRENS NATION MED CTR , Washington , District of Columbia , United States )
  • Hardy, Rose  ( Nationwide Children's Hospital , Columbus , Ohio , United States )
  • Lopez, Keila  ( BAYLOR COLLEGE OF MEDICINE , Houston , Texas , United States )
  • Rudov, Lindsey  ( Louisiana Public Health Institute , New Orleans , Louisiana , United States )
  • Phillippi, Ruth  ( Children's National Hospital , Washington DC , District of Columbia , United States )
  • Agarwal, Anushree  ( USCF , San Francisco , California , United States )
  • Roeder, Mark  ( Adult Congenital Heart Association , Media , Pennsylvania , United States )
  • Saraf, Sneha  ( Children's National Hospital , Washington DC , District of Columbia , United States )
  • Author Disclosures:
    Jamie Jackson: DO NOT have relevant financial relationships | Matthew Lewis: DO NOT have relevant financial relationships | Arwa Saidi: DO NOT have relevant financial relationships | Ronald Kanter: No Answer | Satinder Sandhu: No Answer | THOMAS YOUNG: DO NOT have relevant financial relationships | Roni Jacobsen: DO NOT have relevant financial relationships | Emily Ruckdeschel: No Answer | Adam Lubert: No Answer | Harsimran Singh: No Answer | Ali Zaidi: DO NOT have relevant financial relationships | Rittal Mehta: DO NOT have relevant financial relationships | Dan Halpern: DO NOT have relevant financial relationships | Scott Leezer: DO NOT have relevant financial relationships | Thomas Carton: No Answer | Anitha John: DO NOT have relevant financial relationships | Rose Hardy: DO NOT have relevant financial relationships | Keila Lopez: DO NOT have relevant financial relationships | Lindsey Rudov: DO NOT have relevant financial relationships | Ruth Phillippi: No Answer | Anushree Agarwal: DO NOT have relevant financial relationships | MARK ROEDER: No Answer | Sneha Saraf: DO NOT have relevant financial relationships
Meeting Info:

Scientific Sessions 2024

2024

Chicago, Illinois

Session Info:

Epidemiology and Population Health

Saturday, 11/16/2024 , 09:30AM - 10:55AM

Moderated Digital Poster Session

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