Department of Medicine, Weill Cornell Medicine, New York, New York.
Department of Health Policy and Management, Weill Cornell Medicine, New York, New York.
JAMA Netw Open. 2023 Nov 1;6(11):e2344070. doi: 10.1001/jamanetworkopen.2023.44070.
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.
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.
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.
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.
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).
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.
心力衰竭（HF）住院期间，心脏病专家参与成人治疗与院内死亡率和再住院率降低相关。然而，并非所有住院治疗 HF 的患者都会看心脏病专家。
确定健康的社会决定因素（SDOH）是否与心脏病专家参与管理住院治疗 HF 的成年人有关。
设计、地点和参与者：这是一项使用 Reasons for Geographic and Racial Difference in Stroke（REGARDS）队列数据的回顾性队列研究。参与者包括在美国所有 48 个相邻州经历过经裁定的 HF 住院治疗的成年人。数据分析于 2022 年 11 月至 2023 年 1 月进行。
共检查了 9 个与“健康人民 2030”概念模型一致的候选 SDOH：黑人种族、社会孤立、社交网络和/或护理人员可用性、未完成高中学业、家庭年收入低于 35000 美元、居住在农村地区、居住在贫困率高的邮政编码、居住在卫生专业人员短缺地区、以及居住在公共卫生基础设施差的州。
主要结局是心脏病专家的参与，定义为心脏病专家作为主要负责临床医生或顾问的参与。使用具有稳健 SE 的泊松回归检查每个 SDOH 与心脏病专家参与之间的双变量关联。
该研究纳入了 1000 名参与者（中位数[IQR]年龄，77.8[71.5-84.0]岁；479 名女性[47.9%]；414 名黑人个体[41.4%]；和 876 名低收入者中的 492 名[56.2%]）在 549 家独特的美国医院住院。家庭年收入低（<$35000）是唯一与心脏病专家参与具有统计学显著关联的 SDOH（相对风险，0.88；95%CI，0.82-0.95）。在调整年龄、种族、性别、HF 特征、合并症和医院特征的多变量分析中，低收入者与心脏病专家参与的关联仍然呈负相关（相对风险，0.89；95%CI，0.82-0.97）。
这项队列研究发现，家庭收入较低的成年人在 HF 住院期间接受心脏病专家治疗的可能性比收入较高的成年人低 11%。这些发现表明，社会经济地位可能会影响 HF 住院患者的治疗。
