A subgroup of heart failure patients with more social risk factors had an increased risk of hospitalizations (HR 1.42; 95% CI 1.28-1.58) and emergency department visits (HR 1.33; 95% CI 1.23-1.45).
Cohort (n=3,142)
Yes
Does the co-occurrence of social risk factors increase the risk of emergency department visits and hospitalizations in patients with heart failure?
In patients with heart failure, the co-occurrence of multiple social risk factors, particularly low education, social isolation, and high area-deprivation, is significantly associated with increased risks of ED visits and hospitalizations.
Effect estimate: HR 1.42 (95% CI 1.28-1.58)
Background Among patients with heart failure (HF), social risk factors (SRFs) are associated with poor outcomes. However, less is known about how co-occurrence of SRFs affect all-cause health care utilization for patients with HF. The objective was to address this gap using a novel approach to classify co-occurrence of SRFs. Methods and Results This was a cohort study of residents living in an 11-county region of southeast Minnesota, aged ≥18 years with a first-ever diagnosis for HF between January 2013 and June 2017. SRFs, including education, health literacy, social isolation, and race and ethnicity, were obtained via surveys. Area-deprivation index and rural-urban commuting area codes were determined from patient addresses. Associations between SRFs and outcomes (emergency department visits and hospitalizations) were assessed using Andersen-Gill models. Latent class analysis was used to identify subgroups of SRFs; associations with outcomes were examined. A total of 3142 patients with HF (mean age, 73.4 years; 45% women) had SRF data available. The SRFs with the strongest association with hospitalizations were education, social isolation, and area-deprivation index. We identified 4 groups using latent class analysis, with group 3, characterized by more SRFs, at increased risk of emergency department visits (hazard ratio HR, 1.33 95% CI, 1.23-1.45) and hospitalizations (HR, 1.42 95% CI, 1.28-1.58). Conclusions Low educational attainment, high social isolation, and high area-deprivation index had the strongest associations. We identified meaningful subgroups with respect to SRFs, and these subgroups were associated with outcomes. These findings suggest that it is possible to apply latent class analysis to better understand the co-occurrence of SRFs among patients with HF.
Savitz et al. (Sat,) conducted a cohort in Heart Failure (n=3,142). Co-occurrence of social risk factors (SRFs) vs. Fewer social risk factors was evaluated on Emergency department visits and hospitalizations (HR 1.42, 95% CI 1.28-1.58). A subgroup of heart failure patients with more social risk factors had an increased risk of hospitalizations (HR 1.42; 95% CI 1.28-1.58) and emergency department visits (HR 1.33; 95% CI 1.23-1.45).