Freedland Kenneth E, Steinmeyer Brian C, Skala Judith A, Carney Robert M, Rich Michael W
Washington University School of Medicine St. Louis MO USA.
J Am Heart Assoc. 2025 May 20;14(10):e041458. doi: 10.1161/JAHA.124.041458. Epub 2025 May 13.
Social determinants of health (SDOH) complicate medical care and affect clinical outcomes, but the lack of a reliable structured interview for medical patients has impeded clinical assessment and research on SDOH. We assessed the reliability and validity of a newly developed SDOH Patient Interview Form and investigated SDOH in patients with heart failure.
The SDOH Patient Interview Form was administered to recently hospitalized patients with heart failure between January 2021 and April 2024. The interviews were recorded, and 50 were randomly selected for the interrater reliability analysis.
The sample included 367 participants (mean age, 61.2±12.1 years; 42.5% women; 57.7% minorities). The interrater reliability of SDOH Patient Interview Form categories (eg, Legal and Social Problems) was 100%. The κ reliability coefficients for individual items were ≥0.94. Higher lifetime SDOH counts were associated with lower age and income and higher New York Heart Association class and body mass index. Two distinct sets of problems were found to contribute to relatively high burdens of SDOH. The first originates with abuse in childhood and presents as severe socioeconomic deprivation in adulthood. The second includes losses of family members and occupational, financial, and caregiver stress along with difficulty affording medical care.
The SDOH Patient Interview Form is a reliable instrument for assessing patient-reported SDOH in patients with heart failure. It is suitable for use in research and clinical contexts but requires further testing in other medical patient populations. This study revealed 2 distinct patterns of stressful problems that can contribute to a high overall burden of SDOH.
URL: https://clinicaltrials.gov; Unique identifier: NCT04637776.
健康的社会决定因素（SDOH）使医疗复杂化并影响临床结果，但缺乏针对医疗患者的可靠结构化访谈阻碍了对SDOH的临床评估和研究。我们评估了新开发的SDOH患者访谈表的可靠性和有效性，并调查了心力衰竭患者的SDOH。
2021年1月至2024年4月期间，对近期住院的心力衰竭患者使用SDOH患者访谈表进行访谈。访谈进行了录音，并随机选择50份进行评分者间信度分析。
样本包括367名参与者（平均年龄61.2±12.1岁；42.5%为女性；57.7%为少数族裔）。SDOH患者访谈表各类别（如法律和社会问题）的评分者间信度为100% 单项的κ信度系数≥0.94。较高的终身SDOH计数与较低的年龄和收入以及较高的纽约心脏协会分级和体重指数相关。发现两组不同的问题导致了相对较高的SDOH负担。第一组源于童年期受虐，成年后表现为严重的社会经济剥夺。第二组包括家庭成员的丧失、职业、经济和照顾者压力以及难以负担医疗费用。
SDOH患者访谈表是评估心力衰竭患者报告的SDOH的可靠工具。它适用于研究和临床环境，但需要在其他医疗患者群体中进一步测试 本研究揭示了两种不同模式的应激问题，它们可能导致较高的总体SDOH负担。
