Rahman Justin R, Zachariah Bethany S, Miyake Christina Y, Ansah Deidra, Zachariah Justin P
University of Texas Houston School of Public Health; Houston, TX.
Section of Pediatric Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine; Houston, TX.
J Pediatr Clin Pract. 2025 Apr 10;16:200145. doi: 10.1016/j.jpedcp.2025.200145. eCollection 2025 Jun.
Atherosclerotic risk factors are prevalent in childhood. Risk factors are associated with social determinants of health (SDoH), but have never been demonstrated in a clinical pediatric cardiology cohort. This report details the first use of a remotely deployed, previsit, self-administered electronic survey for the ascertainment of SDoH in youth referred to pediatric cardiology. We hypothesized that patients referred for atherosclerotic risk factors would have higher risk of SDoH factors.
SDoH were assessed using validated instruments from the PRAPARE toolkit and the Accountable Health Communities Health-Related Social Needs Screening Tool automatically deployed days before a scheduled visit in a HIPAA compliant email link to patients. Hypertension, Lipid, and Electrophysiology referral visits were compared to referent General cardiology referral visits using generalized estimating equations to account for repeat visits.
Response rates were similar in each clinic, ranging from 17 to 22%. Compared to General Cardiology (n = 3543 visits), Hypertension referral (n = 1143) was significantly associated with having any SDoH problem (9.3% vs 22%), specifically being concerned about (6.3% vs 15.3%) or actual food insecurity (4.4% vs 12%), and lacking transportation to medical care (0.8% vs 5.3%). Lipid referral (n = 2344) was also associated with being concerned about (6.3% vs 10.2%) or actually food insecure (4.4% vs 8.5%), lacking transport to medical care (0.8% vs 2.6%), and inability to pay for utilities (1.2% vs 3.1%).
Families with youth referred for atherosclerotic risk factors were at higher risk of food insecurity, transportation obstacles to medical visits, and obtaining utilities.
动脉粥样硬化风险因素在儿童期很普遍。风险因素与健康的社会决定因素（SDoH）相关，但从未在临床儿科心脏病学队列中得到证实。本报告详细介绍了首次使用远程部署的、就诊前自我管理的电子调查问卷来确定转诊至儿科心脏病学的青少年的SDoH。我们假设因动脉粥样硬化风险因素而转诊的患者具有更高的SDoH因素风险。
使用PRAPARE工具包和可问责健康社区健康相关社会需求筛查工具中的经过验证的工具，通过符合HIPAA标准的电子邮件链接在预定就诊前几天自动部署给患者，对SDoH进行评估。使用广义估计方程对高血压、血脂和电生理转诊就诊与作为对照的普通心脏病学转诊就诊进行比较，以考虑重复就诊情况。
每个诊所的回复率相似，在17%至22%之间。与普通心脏病学（n = 3543次就诊）相比，高血压转诊（n = 1143）与存在任何SDoH问题显著相关（9.3%对22%），特别是担心（6.3%对15.3%）或实际粮食不安全（4.4%对12%），以及缺乏就医交通（0.8%对5.3%）。血脂转诊（n = 2344）也与担心（6.3%对10.2%）或实际粮食不安全（4.4%对8.5%）、缺乏就医交通（0.8%对2.6%）以及无法支付水电费（1.2%对3.1%）相关。
因动脉粥样硬化风险因素而转诊的青少年家庭面临粮食不安全、就医交通障碍和支付水电费的风险更高。
