B106-03 Neighborhood-Level Vulnerability Is Associated With Mortality in the Pulmonary Hypertension Association Registry Cohort

Abstract Rationale There is growing recognition that individual-level social determinants of health (SDH) (e.g., income, education) impact healthcare outcomes in the United States. This impact may be amplified for patients with pulmonary arterial hypertension (PAH) given the rarity of the disease, expertise required for management, and pathogenesis linked to exposures that disproportionally affect at-risk groups. However, it is largely unknown how neighborhood-level social vulnerability affects disease severity at presentation and mortality among individuals with PAH. Methods We performed an analysis of the national Pulmonary Hypertension Association Registry (PHAR). Patient-level data was geocoded from the time of enrollment and assigned a Social Vulnerability Index (SVI). We used linear regression to evaluate the association between a standard deviation (SD) change in SVI and disease severity at presentation to an expert center (measured by REVEAL 2.0 score). We used Cox proportional hazards to evaluate the association between SVI and all cause-mortality. Staged models were used to understand whether observed relationships were dependent on an individual’s demographics, PAH etiology, individual SDH, distance from home to a PAH center, or REVEAL score. Results Within PHAR, we identified 1,188 adult participants with PAH enrolled between 2015-2024 with all variables of interest. Among these participants, SVI was associated with small differences in disease severity at presentation to a center (β = 0.2 difference in REVEAL per 1 SD increase in SVI 95% CI 0.1-0.3, p 0.001) (Table 1). This association was independent of demographics, PAH etiology, distance to center, and urban/rural classification of their home address but was substantially attenuated when accounting for markers of individual-level SDH. SVI was also associated with mortality (HR = 1.17 per 1 SD increase in SVI 95% CI 1.06-1.30, p = 0.001). This relationship was independent of demographics, PAH etiology, distance to center, and urban/rural classification. With adjustment for markers of individual-level SDH or disease severity at presentation to a center, the relationship was attenuated but persistent. This finding suggests that people from vulnerable neighborhoods may present to PAH centers with worse disease severity, but this difference does not completely account for the relationship between neighborhood-level vulnerability and worse mortality. Conclusions In the PHAR cohort, neighborhood-level social vulnerability was associated with worse survival, independent of initial disease severity, demographics, or distance to center. Further analysis is needed to explore residual confounders and potential mediators in the care pathway for people with PAH, including how social vulnerability impacts treatment patterns, referral rates to supportive services, and healthcare utilization. This abstract is funded by: None