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- Title
Social Determinants of Health and Cardiologist Involvement in the Care of Adults Hospitalized for Heart Failure.
- Authors
Zhang, David T.; Onyebeke, Chukwuma; Nahid, Musarrat; Balkan, Lauren; Musse, Mahad; Pinheiro, Laura C.; Sterling, Madeline R.; Durant, Raegan W.; Brown, Todd M.; Levitan, Emily B.; Safford, Monika M.; Goyal, Parag
- Abstract
Key Points: Question: Are social determinants of health associated with cardiologist involvement in the management of adults hospitalized for heart failure? Findings: This cohort study of 1000 participants hospitalized for heart failure at 549 unique US hospitals found that low income was inversely associated with cardiologist involvement after adjusting for patient-based and hospital-based factors. Meaning: These findings identify socioeconomic status as an important social determinant of health that may bias the care provided to patients hospitalized for heart failure. This cohort study examines whether social determinants of health are associated with cardiologist involvement in the management of adults hospitalized with heart failure (HF). Importance: Involvement of a cardiologist in the care of adults during a hospitalization for heart failure (HF) is associated with reduced rates of in-hospital mortality and hospital readmission. However, not all patients see a cardiologist when they are hospitalized for HF. Objective: To determine whether social determinants of health (SDOH) are associated with cardiologist involvement in the management of adults hospitalized for HF. Design, Setting, and Participants: This retrospective cohort study used data from the Reasons for Geographic and Racial Difference in Stroke (REGARDS) cohort. Participants included adults who experienced an adjudicated hospitalization for HF between 2009 and 2017 in all 48 contiguous states in the US. Data analysis was performed from November 2022 to January 2023. Exposures: A total of 9 candidate SDOH, aligned with the Healthy People 2030 conceptual model, were examined: Black race, social isolation, social network and/or caregiver availability, educational attainment less than high school, annual household income less than $35 000, living in rural area, living in a zip code with high poverty, living in a Health Professional Shortage Area, and living in a state with poor public health infrastructure. Main Outcomes and Measures: The primary outcome was cardiologist involvement, defined as involvement of a cardiologist as the primary responsible clinician or as a consultant. Bivariate associations between each SDOH and cardiologist involvement were examined using Poisson regression with robust SEs. Results: The study included 1000 participants (median [IQR] age, 77.8 [71.5-84.0] years; 479 women [47.9%]; 414 Black individuals [41.4%]; and 492 of 876 with low income [56.2%]) hospitalized at 549 unique US hospitals. Low annual household income (<$35 000) was the only SDOH with a statistically significant association with cardiologist involvement (relative risk, 0.88; 95% CI, 0.82-0.95). In a multivariable analysis adjusting for age, race, sex, HF characteristics, comorbidities, and hospital characteristics, low income remained inversely associated with cardiologist involvement (relative risk, 0.89; 95% CI, 0.82-0.97). Conclusions and Relevance: This cohort study found that adults with low household income were 11% less likely than adults with higher incomes to have a cardiologist involved in their care during a hospitalization for HF. These findings suggest that socioeconomic status may bias the care provided to patients hospitalized for HF.
- Subjects
HEART failure treatment; SOCIAL determinants of health; CAREGIVERS; CARDIOLOGISTS; MATHEMATICAL models; SOCIAL networks; RETROSPECTIVE studies; RACE; REGRESSION analysis; SOCIAL isolation; INCOME; HOSPITAL care; THEORY; DESCRIPTIVE statistics; RESEARCH funding; LONGITUDINAL method; EDUCATIONAL attainment; ADULTS
- Publication
JAMA Network Open, 2023, Vol 6, Issue 11, pe2344070
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2023.44070