Complex Interactions of Social Determinants of Health on Survival Outcomes in Hispanic Patients With Pulmonary Arterial Hypertension in a US-Mexican Border City.

IF 1.4 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Cardiology Research Pub Date : 2025-06-01 Epub Date: 2025-04-22 DOI:10.14740/cr1748
Hedaia Algheriani, Marco Cazares-Parson, Michael Brockman, Bobak Zakhireh, Sunil Srinivas, Debabrata Mukherjee, Alok K Dwivedi, Nils P Nickel
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引用次数: 0

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

美墨边境城市西班牙裔肺动脉高压患者生存结局中健康社会决定因素的复杂相互作用
背景:肺动脉高压(PAH)是一种慢性肺血管疾病,可导致右心衰,如果不及时治疗,会导致发病率和死亡率增加。虽然右心血流动力学和功能能力是PAH预后的一个公认的预测指标,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及其复杂的相互作用对美墨边境西班牙裔患者群体生存的影响。方法:采用Cox比例风险模型和潜在分类分析对158例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,次要分析检查单个和联合SDOH对生存的影响。结果:平均随访3.8年(0.2 ~ 6年),37例(23.4%)患者死亡。缺乏医疗保险(风险比2.17;95%置信区间(CI): 1.05 - 4.49, P = 0.037)和失业率(HR 2.99;95% CI: 1.42 - 6.30, P = 0.004)与随访5年内死亡风险升高显著相关。潜在变量模型显示,年龄≥60岁、无保险、未结婚、无业以及PAH严重程度较高(以心输出量、平均肺动脉压、6分钟步行距离和世界卫生组织功能等级bbb2.0测量)的患者发生不良结局的风险最高(HR 3.6, 95% CI: 1.9 - 6.8, P < 0.001)。有趣的是,保险类型对生存率没有显著影响。结论:研究结果强调了改善西班牙裔弱势群体获得保险覆盖和加强社会支持的迫切需要,以促进更好的健康结果。解决这些SDOH问题对于缩小PAH患者的健康差距和提高生存率至关重要。
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来源期刊
Cardiology Research
Cardiology Research CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
2.50
自引率
0.00%
发文量
42
期刊介绍: Cardiology Research is an open access, peer-reviewed, international journal. All submissions relating to basic research and clinical practice of cardiology and cardiovascular medicine are in this journal''s scope. This journal focuses on publishing original research and observations in all cardiovascular medicine aspects. Manuscript types include original article, review, case report, short communication, book review, letter to the editor.
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