Race, Social Determinants of Health, and Comorbidity Patterns Among Participants with Heart Failure in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study.
Ene M Enogela, Parag Goyal, Elizabeth A Jackson, Monika M Safford, Stephen Clarkson, Thomas W Buford, Todd M Brown, D Leann Long, Raegan W Durant, Emily B Levitan
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Abstract
Background: Among individuals with heart failure (HF), racial differences in comorbidities may be mediated by social determinants of health (SDOH).
Methods: Black and White US community-dwelling participants in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study aged ≥ 45 years with an adjudicated HF hospitalization between 2003 and 2017 were included in this cross-sectional analysis. We assessed whether higher prevalence of comorbidities in Black participants compared to White participants were mediated by SDOH in socioeconomic, environment/housing, social support, and healthcare access domains, using the inverse odds weighting method.
Results: Black (n = 240) compared to White (n = 293) participants with HF with preserved ejection fraction (HFpEF) had higher prevalence of diabetes [1.38 (95% CI: 1.18 - 1.61)], chronic kidney disease [1.21 (95% CI: 1.01 - 1.45)], and anemia [1.33 (95% CI: 1.02 - 1.75)] and lower prevalence of atrial fibrillation [0.80 (95% CI: (0.65 - 0.98)]. Black (n = 314) compared to White (n = 367) participants with HF with reduced ejection fraction (HFrEF) had higher prevalence of hypertension [1.04 (95% CI: 1.02 - 1.07)] and diabetes [1.26 (95% CI: 1.09 - 1.45)] and lower prevalence of coronary artery disease [0.86 (95% CI: 0.78 - 0.94)] and atrial fibrillation [0.70 (95% CI: 0.58 - 0.83)]. Socioeconomic status explained 14.5%, 26.5% and 40% of excess diabetes, anemia, and chronic kidney disease among Black adults with HFpEF; however; mediation was not statistically significant and no other SDOH substantially mediated differences in comorbidity prevalence.
Conclusions: Socioeconomic status partially mediated excess diabetes, anemia, and chronic kidney disease experienced by Black adults with HFpEF, but differences in other comorbidities were not explained by other SDOH examined.
期刊介绍：
Discover Social Science and Health is an interdisciplinary, international journal that publishes papers at the intersection of the social and biomedical sciences. Papers should integrate, in both theory and measures, a social perspective (reflecting anthropology, criminology, economics, epidemiology, policy, sociology, etc) and a concern for health (mental and physical). Health, broadly construed, includes biological and other indicators of overall health, symptoms, diseases, diagnoses, treatments, treatment adherence, and related concerns. Drawing on diverse, sound methodologies, submissions may include reports of new empirical findings (including important null findings) and replications, reviews and perspectives that construe prior research and discuss future research agendas, methodological research (including the evaluation of measures, samples, and modeling strategies), and short or long commentaries on topics of wide interest. All submissions should include statements of significance with respect to health and future research. Discover Social Science and Health is an Open Access journal that supports the pre-registration of studies.
Topics
Papers suitable for Discover Social Science and Health will include both social and biomedical theory and data. Illustrative examples of themes include race/ethnicity, sex/gender, socioeconomic, geographic, and other social disparities in health; migration and health; spatial distribution of risk factors and access to healthcare; health and social relationships; interactional processes in healthcare, treatments, and outcomes; life course patterns of health and treatment regimens; cross-national patterns in health and health policies; characteristics of communities and neighborhoods and health; social networks and treatment adherence; stigma and disease progression; methodological studies including psychometric properties of measures frequently used in health research; and commentary and analysis of key concepts, theories, and methods in studies of social science and biomedicine. The journal welcomes submissions that draw on biomarkers of health, genetically-informed and neuroimaging data, psychophysiological measures, and other forms of data that describe physical and mental health, access to health care, treatment, and related constructs.
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