Abstract 15779: Unfavorable Social Determinants of Health Profile and Financial Toxicity From Healthcare in Atherosclerotic Cardiovascular Disease

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Javier Valero Elizondo ◽  
Rohan Khera ◽  
Ramzi Dudum ◽  
Isaac Acquah ◽  
Adnan Hyder ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Cumulative Effect ◽  
Determinants Of Health ◽  
Risk Scores ◽  
Atherosclerotic Cardiovascular Disease ◽  
Financial Toxicity ◽  
Neighborhood Conditions ◽  
Increased Risk

Introduction: Healthcare expenses for atherosclerotic cardiovascular disease (ASCVD) are associated with substantial financial toxicity (FT). Whether certain social determinants of health (SDOH) portend an increased risk of FT in ASCVD is critical to refine care processes that may be most amenable to interventions. Methods: Using National Health Interview Survey (2013-17), we assessed patients with self-reported ASCVD. We identified 35 discrete SDOH items, rated as favorable/unfavorable, across 6 domains: economic stability, education, food access, neighborhood conditions, social context, and health systems. To capture the cumulative effect of SDOH, an aggregate score was computed as their sum, and divided into quartiles, the highest quartile containing the most unfavorable scores. FT included presence of: difficulty paying medical bills/inability to pay them at all, and/or delayed/foregone care due to cost, and/or cost-related medication non-adherence. Results: Of 164,696 surveyed adults, of which 15,758 (weighted: 8%) reported ASCVD. Mean (SE) age-adjusted SDOH risk scores among ASCVD vs non-ASCVD patients were 11.8 (0.12) vs 9.5 (0.03), respectively. Among individuals with ASCVD, age-adjusted prevalence of any FT was directly proportional to SDOH aggregate scores, with step-wise increases noted. Prevalence of ≥ 2 FT factors among SDOH quartiles 1 st vs 4 th was 8% vs 50% among non-elderly (< 65), and 2% vs 35% among elderly adults with ASCVD, respectively (Figure). Further, in adjusted models, patients in the most unfavorable quartile for SDOH had an 8-fold higher likelihood of FT compared to those in the most favorable group. Conclusions: Among ASCVD patients, a higher number of unfavorable SDOH features is strongly associated with the presence of FT, further calling for the development of interventions to alleviate FT among those with unfavorable SDOH profiles.

scholarly journals EPID-09. QUANTIFYING SOCIAL DETERMINANTS OF HEALTH AMONG GLIOMA PATIENTS

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii80-ii80
Author(s):  
Angelica Hutchinson ◽  
Alexandria Marshall ◽  
Fang-Chi Hsu ◽  
Kathryn Weaver ◽  
Alisha DeTroye ◽  
...  
Keyword(s):  
Health Risk ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Active Treatment ◽  
Economic Education ◽  
Neighborhood Environment ◽  
Determinants Of Health ◽  
Risk Scores ◽  
Diffuse Astrocytoma ◽  
Modifiable Factors

Abstract BACKGROUND Social determinants of health (SDH) are modifiable factors that contribute to health outcomes. Despite studies linking SDHs with cervical, ovarian, and prostate cancer outcomes, few studies have explored SDHs in glioma patients. We conducted a cross-sectional survey to characterize and contextualize SDHs in glioma patients by community income, rural/urban residence, and treatment status. METHODS Two validated instruments: PRAPARE (Protocol for responding to and assessing patents’ assets risks and experiences) and AHC (accountable health communities instrument) quantified SDHs; along with study-specific supplemental questions. Risk scores were calculated and combined into an overall and domain-specific (economic, education, neighborhood environment, social context, and healthcare) SDH risk, with a higher score being indicative of higher SDH risk. Scores were compared between low-income (LIC) vs high-income (HIC) communities (defined by median household income), urban vs rural (defined by zip code), and active treatment vs surveillance (determined by patient medical record) using Wilcoxon rank-sum test. RESULTS 100 glioma patients were enrolled: mean age 53 years (range: 22–78); 49% male; 18% oligodendroglioma, 34% diffuse astrocytoma, 38% glioblastoma, 10% other glioma; 68% resided in LICs, 27% in rural zip codes, and 51% were on active treatment. Overall, SDH risk scores were low (mean= 4.43-out-of-38). Scores in the healthcare domain were the highest. Compared to patients from LICs, patients from HICs had higher healthcare risk scores (p&lt; 0.05). Surveillance patients had higher overall SDH risk on the AHC than patients in active treatment (p&lt; 0.05), with age being a confounder. In multivariable analysis, younger age, and astrocytoma histology were associated with higher social health risk. CONCLUSION Glioma patients report relatively few SDH risk factors on standardized instruments designed for general clinic populations. The higher health risk observed in patients in HICs and higher AHC risk for those in surveillance will be further explored in planned qualitative analysis.

600 Social Determinants and Their Impact on Burn Surgery Outcomes

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S151-S152
Author(s):  
Luis H Quiroga ◽  
Tomer Lagziel ◽  
Mohammed Asif ◽  
Raymond Fang ◽  
Grace F Rozycki ◽  
...  
Keyword(s):  
Mental Health ◽  
Diabetes Mellitus ◽  
Social Determinants Of Health ◽  
Population Health ◽  
Social Determinants ◽  
Determinants Of Health ◽  
Hospital Charges ◽  
Burn Patients ◽  
Increased Risk ◽  
History Of

Abstract Introduction To our knowledge, no studies have been conducted assessing the social determinants of health and the impact on the outcomes for burn patients. Such studies are needed considering burn injuries are associated with high costs, severe psychological impact, and a high burden placed on the healthcare systems. The burden is hypothesized to be aggravated by the increasing amount of diabetes and obesity seen in the general population which put patients at increased risk for developing chronic wounds. Studies have shown that several socioeconomic status (SES) factors are associated with increased risk of burns, but none have documented the outcomes of burn patients based on their social determinants of health. In our study, we will be comparing patients in the burn ICU (BICU) to patients in the surgical ICU (SICU). The purpose of this comparison is to evaluate whether the same social determinants of health have similar influences in both groups. Methods We performed a retrospective analysis of population group data from patients admitted to the BICU and SICU from January 1, 2016, to November 18, 2019. The primary outcomes were length-of-stay (LOS), mortality, 30-day-readmission, and hospital charges. Pearson’s chi-square test for categorical variables and t-test for continuous variables were used to compare population health groups. Results We analyzed a total of 487 burn and 510 surgical patients. When comparing BICU and SICU patients, we observed significantly higher mean hospital charges and LOS in burn patients with a history of mental health (mean difference: $42,756.04, p=0.013 and 7.12 days, p=0.0085), ESRD ($57,8124.7, p=0.0047 and 78.62 days, p=0.0104), sepsis ($168,825.19, p=&lt; 0.001 and 20.68 days, p=0.0043), and VTE ($63,9924.1, p=&lt; 0.001 and 72.9 days, p=0.002). Also, higher mortality was observed in burn patients with ESRD, STEMI, sepsis, VTE, and diabetes mellitus. Burn patients with a history of mental health, drug dependence, heart failure, and diabetes mellitus also had greater 30-day-readmissions rates. Conclusions This study sheds new knowledge on the considerable variability that exists between the different population health groups in terms of outcomes for each cohort of critically ill patients. It demonstrates the impacts of population health group on outcomes. These population groups and social determinants have different effects on BICU versus SICU patients and this study provides supporting evidence for the need to identify and develop new strategies to decrease overspending in healthcare. Further research to develop relevant and timely interventions that can improve these outcomes.

scholarly journals The Power of Partnerships: State Public Health Department Multisector Collaborations in Major Chronic Disease Program Areas

2021 ◽  
Author(s):  
Edward Tsai ◽  
Peg Allen ◽  
Louise F Saliba ◽  
Ross C Brownson
Keyword(s):  
Public Health ◽  
Cardiovascular Disease ◽  
Chronic Disease ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Online Survey ◽  
Health Sector ◽  
Determinants Of Health ◽  
Public Health Department ◽  
Work Unit

Abstract Background Multisector collaboration between state health departments (SHDs) and diverse community partners is increasingly recognized as important for promoting positive public health outcomes, addressing social determinants of health, and reducing health inequalities. This study investigates collaborations between SHDs and different types of organizations addressing chronic disease in and outside of the health sector. Methods SHD employees were randomly selected from the National Association of Chronic Disease Directors membership list for participation in an online survey. Participants were asked about their primary chronic disease work unit (cancer, obesity, tobacco, diabetes, cardiovascular disease, and others), as well as their work unit collaborations (exchange of information/cooperation in activities) with organizations in health and non-health sectors. As a measure of the different organizations SHDs collaborated with in health and non-health sectors, a collaboration heterogeneity score for each program area was calculated. One-way ANOVA with Tukey’s post hoc tests were used to assess differences in collaborator heterogeneity between program areas. Results A total of 574 participants were surveyed. Results indicated the cancer program area, along with diabetes and cardiovascular disease, had significantly less collaboration heterogeneity with organizations outside of the health sector compared to the obesity and tobacco program areas. Conclusions Evidence suggests that to address social determinants of health and promote health equity, increased public health collaborations with diverse non-health sector community-based settings is critical.

scholarly journals Integrating Social Determinants of Health and Laboratory Data: A Pilot Study To Evaluate Co-Use of Opioids and Benzodiazepines

2019 ◽  
Vol 6 ◽  
pp. 237428951988487 ◽  
Author(s):  
Jill S. Warrington ◽  
Nick Lovejoy ◽  
Jamie Brandon ◽  
Keith Lavoie ◽  
Chris Powell
Keyword(s):  
Pilot Study ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Clinical Care ◽  
Laboratory Finding ◽  
Laboratory Data ◽  
Determinants Of Health ◽  
Opioid Use ◽  
Opioid Crisis ◽  
Increased Risk

As the opioid crisis continues to have devastating consequences for our communities, families, and patients, innovative approaches are necessary to augment clinical care and the management of patients with opioid use disorders. As stewards of health analytic data, laboratories are uniquely poised to approach the opioid crisis differently. With this pilot study, we aimed to bridge laboratory data with social determinants of health data, which are known to influence morbidity and mortality of patients with substance use disorders. For the purpose of this pilot study, we focused on the co-use of opioids and benzodiazepines, which can lead to an increased risk of fatal opioid-related overdoses and increased utilization of acute care. Using the laboratory finding of the copresence of benzodiazepines and opioids as the primary outcome measure, we examined social determinants of health attributes that predict co-use. We found that the provider practice that ordered the laboratory result is the primary predictor of co-use. Increasing age was also predictive of co-use. Further, co-use is highly prevalent in specific geographic areas or “hotspots.” The prominent geographic distribution of co-use suggests that targeted educational initiatives may benefit the communities in which co-use is prevalent. This study exemplifies the Clinical Lab 2.0 approach by leveraging laboratory data to gain insights into the overall health of the patient.

Polysocial Risk Scores for Assessing Social Determinants of Health

JAMA ◽  
2020 ◽  
Vol 324 (16) ◽  
pp. 1680
Author(s):  
Stuart A. Kinner ◽  
Rohan Borschmann
Keyword(s):  
Social Determinants Of Health ◽  
Social Determinants ◽  
Determinants Of Health ◽  
Risk Scores

scholarly journals Social Determinants of Myocardial Infarction Risk and Survival: A Systematic Review

2020 ◽  
pp. 1-12
Author(s):  
Steven S. Coughlin ◽  
Steven S. Coughlin ◽  
Lufei Young
Keyword(s):  
Myocardial Infarction ◽  
Social Support ◽  
Socioeconomic Status ◽  
Social Determinants Of Health ◽  
Low Socioeconomic Status ◽  
Social Determinants ◽  
Determinants Of Health ◽  
Access To Health Services ◽  
Immigration Status ◽  
Increased Risk

Social determinants of health that have been examined in relation to myocardial infarction incidence and survival include socioeconomic status (income, education), neighbourhood disadvantage, immigration status, social support, and social network. Other social determinants of health include geographic factors such as neighbourhood access to health services. Socioeconomic factors influence risk of myocardial infarction. Myocardial infarction incidence rates tend to be inversely associated with socioeconomic status. In addition, studies have shown that low socioeconomic status is associated with increased risk of poorer survival. There are well-documented disparities in myocardial infarction survival by socioeconomic status, race, education, and census-tract-level poverty. The results of this review indicate that social determinants such as neighbourhood disadvantage, immigration status, lack of social support, and social isolation also play an important role in myocardial infarction risk and survival. To address these social determinants and eliminate disparities, effective interventions are needed that account for the social and environmental contexts in which heart attack patients live and are treated.

scholarly journals A rapid qualitative assessment of the impact of the COVID-19 pandemic on a racially/ethnically diverse sample of gay, bisexual, and other men who have sex with men living with HIV in the US South

2020 ◽  
Author(s):  
Scott D. Rhodes ◽  
Lilli Mann-Jackson ◽  
Jorge Alonzo ◽  
Manuel Garcia ◽  
Amanda E. Tanner ◽  
...  
Keyword(s):  
Social Determinants Of Health ◽  
Social Determinants ◽  
Ethnically Diverse ◽  
Determinants Of Health ◽  
Qualitative Assessment ◽  
Increased Risk ◽  
Persons Living With Hiv ◽  
Sex With Men ◽  
Living With Hiv ◽  
The Impact

Abstract Persons living with HIV (PLWH) may be at increased risk for severe COVID-19-related illness. Our community-based participatory research partnership collected and analyzed semi-structured interview data to understand the early impact of the COVID-19 pandemic on a sample of racially/ethnically diverse gay, bisexual, and other men who have sex with men living with HIV. Fifteen cisgender men participated; their mean age was 28. Six participants were Black/African American, five were Spanish-speaking Latinx, and four were White. Seventeen themes emerged that were categorized into six domains: knowledge and perceptions of COVID-19; COVID-19 information sources and perceptions of trustworthiness; impact of COVID-19 on behaviors, health, and social determinants of health; and general COVID-19-related concerns. Interventions are needed to ensure that PLWH have updated information and adhere to medication regimens, and to reduce the impact of COVID-19 on social isolation, economic stability, healthcare access, and other social determinants of health within this vulnerable population.

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