Streur Megan M, Auld Jonathan P, Chang Wei-Lun, Choupani Fatemeh, Zheng Tao, Frazier Elizabeth, Liberato Ana Carolina Sauer, Pike Kenneth C, Thompson Elaine A, Dougherty Cynthia M
School of Nursing, Department of Biobehavioral Nursing and Health Informatics University of Washington Seattle WA USA.
Department of Medicine, Division of Cardiology University of Washington Seattle WA USA.
J Am Heart Assoc. 2025 May 20;14(10):e039238. doi: 10.1161/JAHA.124.039238. Epub 2025 May 14.
Disparities in implantable cardioverter-defibrillator (ICD) implant rates and survival to hospital discharge exist, negatively impacting Black individuals, women, or people with lower socioeconomic status. This study examined if social determinants of health (SDOH) were associated with ICD shocks, all-cause hospitalization, death, or patient-reported outcomes during the first year following an initial ICD.
This secondary analysis used data from a comparative effectiveness randomized controlled trial of a post-ICD patient intervention. Participants were followed for 1 year, and outcomes included ICD shocks, hospitalizations, death, physical function, psychological adjustment, and self-efficacy. SDOH indicators included age, biological sex, race and ethnicity, education level, employment status, household income, and rural/urban residence. Descriptive statistics, Pearson's , and multivariate logistic regression were used to examine differences in outcomes by SDOH across the first year after ICD implant.
Participants (N=301) were aged 64±12 years; 1% Asian/Pacific Islander, 4% Black, 2% Latinx, 2% Native American/Alaskan, and 91% White; 74% men; 87% urban residents; 65% retired/disabled/unemployed; 45% household income <$50 000/year; and 48% high school/vocational education or less. No significant associations were observed between SDOH and ICD shocks, hospitalization, or death. Physical health improved less for individuals with household income <$50 000 (<0.001), while White participants (=0.03) and rural residents (=0.01) showed a greater reduction in ICD concerns.
SDOH were not associated with the incidence of ICD shocks, hospitalization, or death in the first year after receipt of an initial ICD. There were limited differences in the change in patient-reported outcomes over time by SDOH.
植入式心脏转复除颤器（ICD）植入率及出院生存率存在差异，对黑人、女性或社会经济地位较低的人群产生了负面影响。本研究探讨了健康的社会决定因素（SDOH）与首次植入ICD后第一年的ICD电击、全因住院、死亡或患者报告结局之间是否存在关联。
本二次分析使用了一项ICD术后患者干预的比较有效性随机对照试验的数据。对参与者进行了1年的随访，结局包括ICD电击、住院、死亡、身体功能、心理调适和自我效能感。SDOH指标包括年龄、生物性别、种族和民族、教育水平、就业状况、家庭收入以及农村/城市居住情况。采用描述性统计、Pearson's检验和多因素逻辑回归分析来研究ICD植入后第一年SDOH在结局方面的差异。
参与者（N = 301）年龄为64±12岁；1%为亚太岛民，4%为黑人，2%为拉丁裔，2%为美洲原住民/阿拉斯加人，91%为白人；74%为男性；87%为城市居民；65%退休/残疾/失业；45%家庭收入<50000美元/年；48%接受过高中/职业教育或更低水平教育。未观察到SDOH与ICD电击、住院或死亡之间存在显著关联。家庭收入<50000美元的个体身体健康改善较少（<0.001），而白人参与者（=0.03）和农村居民（=0.01）对ICD的担忧减少幅度更大。
SDOH与首次接受ICD后第一年的ICD电击、住院或死亡发生率无关。SDOH在患者报告结局随时间变化方面的差异有限。
