Algheriani Hedaia, Cazares-Parson Marco, Brockman Michael, Zakhireh Bobak, Srinivas Sunil, Mukherjee Debabrata, Dwivedi Alok K, Nickel Nils P
Department of Internal Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA.
Paul L. Foster School of Medicine, El Paso, TX, USA.
Cardiol Res. 2025 Jun;16(3):189-196. doi: 10.14740/cr1748. Epub 2025 Apr 22.
Pulmonary arterial hypertension (PAH) is a chronic disease of the pulmonary blood vessels that can lead to right heart failure, resulting in increased morbidity and mortality if left untreated. While right heart hemodynamics and functional capacity are a well-established predictors of outcome in PAH, emerging evidence suggests that social determinants of health (SDOH) may have a significant impact on patients with PAH, influencing outcomes and survival rates. This study explores the impact of SDOH and their intricate interactions on survival among a Hispanic patient cohort along the US-Mexico border.
A retrospective analysis was conducted on a single-center cohort of 158 PAH patients (72% female, mean age 58 years) using Cox proportional hazards models and latent class analyses. The primary outcome was mortality during the follow-up period, with secondary analyses examining the impact of individual and combined SDOH on survival.
During a mean follow-up period of 3.8 years (range: 0.2 to 6 years), 37 patients (23.4%) died. Lack of health insurance (hazard ratio (HR) 2.17; 95% confidence interval (CI): 1.05 - 4.49, P = 0.037) and unemployment (HR 2.99; 95% CI: 1.42 - 6.30, P = 0.004) were significantly associated with a higher risk of death within 5 years of follow-up. Latent variable modeling revealed that patients aged ≥ 60 years, who were uninsured, unmarried, and unemployed along with greater PAH severity (measured with cardiac output, mean pulmonary arterial pressure, six-minute walk distance, and World Health Organization Functional Class > 2) had the highest risk of poor outcomes (HR 3.6, 95% CI: 1.9 - 6.8, P < 0.001). Interestingly, the type of insurance did not have a significant impact on survival.
The findings underscore the critical need for improved access to insurance coverage and enhanced social support to promote better health outcomes among this vulnerable Hispanic population. Addressing these SDOH is essential in closing the health disparity gap and improving survival rates in PAH patients.
肺动脉高压（PAH）是一种肺部血管的慢性疾病，可导致右心衰竭，若不治疗，发病率和死亡率会增加。虽然右心血流动力学和功能能力是PAH预后的既定预测指标，但新出现的证据表明，健康的社会决定因素（SDOH）可能对PAH患者有重大影响，影响预后和生存率。本研究探讨了SDOH及其复杂相互作用对美墨边境西班牙裔患者队列生存率的影响。
使用Cox比例风险模型和潜在类别分析，对一个单中心队列的158名PAH患者（72%为女性，平均年龄58岁）进行回顾性分析。主要结局是随访期间的死亡率，次要分析考察个体和综合SDOH对生存的影响。
在平均3.8年（范围：0.2至6年）的随访期内，37名患者（23.4%）死亡。缺乏医疗保险（风险比（HR）2.17；95%置信区间（CI）：1.05 - 4.49，P = 0.037）和失业（HR 2.99；95%CI：1.42 - 6.30，P = 0.004）与随访5年内较高的死亡风险显著相关。潜在变量模型显示，年龄≥60岁、未参保、未婚、失业且PAH严重程度更高（用心输出量、平均肺动脉压、六分钟步行距离和世界卫生组织功能分级>2衡量）的患者预后不良风险最高（HR 3.6，95%CI：1.9 - 6.8，P < 0.001）。有趣的是，保险类型对生存没有显著影响。
研究结果强调迫切需要改善保险覆盖范围和加强社会支持，以促进这一脆弱西班牙裔人群获得更好的健康结局。解决这些SDOH对于缩小健康差距和提高PAH患者的生存率至关重要。
