Prevalence and Impact of Adverse Social and Behavioral Determinants of Health in Heart Failure: Analysis of a Safety-Net Population.

IF 1.2 4区医学 Q4 HEALTH POLICY & SERVICES Journal of Health Care for the Poor and Underserved Pub Date : 2024-01-01

Lucas Zellmer, Maroun Chedid, Appesh Mohandas, Holly Rodin, Katherine Diaz Vickery, Gautam R Shroff

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Abstract

Objective: To determine the impact of adverse social and behavioral determinants of health (SBDH) on health care use in a safety-net community hospital (SNCH) heart failure (HF) population.

Methods: We performed a retrospective analysis of HF patients at a single SNCH between 2018-2019 (N= 4594).

Results: At least one adverse SBDH was present in 21% of the study population. Patients with at least one adverse SBDH were younger (57 vs. 68 years), more likely to identify as Black (50% vs. 36%), be male (68% vs. 53%), and have Medicaid insurance (48% vs. 22%), p<.001. Presence of at least one adverse SBDH (homelessness, substance use, or incarceration) correlated with increased hospitalizations (2.3 vs 1.4/patient) and ED visits (5.1 vs 2.1/patient), p<.0001. Adverse SBDH were independent predictors of HF readmissions. Prescribing of guideline-directed medical therapy was similar among all patients.

Conclusions: In a SNCH HF cohort, adverse SBDH predominantly afflict younger Black men on Medicaid and are associated with increased utilization.

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不良社会和行为健康决定因素在心力衰竭患者中的流行程度和影响：安全网人群分析。

目的确定不利的社会和行为健康决定因素（SBDH）对安全网社区医院（SNCH）心力衰竭（HF）人群使用医疗服务的影响：我们对2018-2019年间一家社区医院的心衰患者（N= 4594）进行了回顾性分析：21%的研究人群中至少存在一种不良SBDH。至少存在一种不良 SBDH 的患者更年轻（57 岁 vs. 68 岁）、更有可能被认定为黑人（50% vs. 36%）、男性（68% vs. 53%）和拥有医疗补助保险（48% vs. 22%），p<.001。至少存在一种不利的 SBDH（无家可归、药物使用或监禁）与住院率（2.3 vs 1.4/人）和急诊室就诊率（5.1 vs 2.1/人）的增加相关，p<.0001。不良 SBDH 是高血压再入院的独立预测因素。所有患者的指导性药物治疗处方相似：结论：在 SNCH HF 队列中，不良 SBDH 主要影响接受医疗补助的年轻黑人男性，并与使用率增加有关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Health Care for the Poor and Underserved Multiple-

CiteScore

2.00

自引率

7.10%

发文量

154

期刊介绍： The journal has as its goal the dissemination of information on the health of, and health care for, low income and other medically underserved communities to health care practitioners, policy makers, and community leaders who are in a position to effect meaningful change. Issues dealt with include access to, quality of, and cost of health care.