Higher Risk SDOH Linked to Reduced HRQOL in Older Patients With Heart Disease

Higher risk social determinants of health (SDOH) profiles are associated with lower health-related quality of life (HRQOL) and reduced advance care planning completion among Medicare beneficiaries with heart disease, according to a study in the Journal of Pain and Symptom Management.

The retrospective secondary analysis used data from the National Health and Aging Trends Study (NHATS) to evaluate the association of multidimensional SDOH measures with HRQOL, advance care planning, and treatment preferences in older patients with heart disease.

The study population had self-reported heart disease and participated in a survey round that included a module titled End of Life Plans and Care. Latent class analysis was used to identify profiles of SDOH with similar categoric distributions among 12 SDOH indicators within the NHATS Economic and Social Consequences key concept area.

The cohort included 1202 participants with a history of heart disease. Their median age was 81 years, 57% were women, 70% were White non-Hispanic, 21% were Black non-Hispanic, and 10% were classified as other.

The high/medium-risk (22%) and low-risk (78%) SDOH profiles were identified after the high- and medium-risk profiles were combined. Individuals in the high/medium-risk SDOH profile reported receiving state Medicaid more frequently vs those in the low-risk SDOH profile (79.4% vs 0.3%, P <.001).

High-risk SDOH profile individuals were more likely to be women (P <.0001) and non-Hispanic Black or other (P <.0001) and less likely to be married/living with a partner (P <.0001). Participants in the high-risk SDOH profile were more likely to have fair or poor HRQOL (P <.0001) and less likely to have advance care planning (P <.0001). High-risk SDOH profile individuals were more likely to want life-prolonging treatment if needed (P <.0001).

In the multivariable adjusted multinomial logistic regression analysis after adjustment for age, sex, marital status, and race/ethnicity, high-risk SDOH profile individuals were more likely to report good HRQOL vs very good/excellent (odds ratio [OR], 1.62; 95% CI, 1.00-2.62; P =.05), fair HRQOL vs very good/excellent HRQoL (OR, 2.43; 95% CI, 1.50-3.91; P <.001), and poor HRQOL vs very good/excellent HRQoL (OR, 4.05; 95% CI, 2.29-7.16; P <.001). Participants who were more likely (with statistical significance P <.05) to have poor HRQOL vs those with very good/excellent HRQoL were women (OR, 1.63; 95% CI, 1.02-2.61) vs men and other race (OR, 3.84; 95% CI, 1.63-9.06) vs non-Hispanic White.

No significant association was observed between SDOH and treatment preferences (P =.344) in the adjusted regression, unlike the statistically significant association (P <.01) in the univariate analyses. Women (OR, 0.72; 95% CI, 0.53-0.97; P <.03) were less likely to request life-prolonging treatments compared with men, and non-Hispanic Black (OR, 4.02; 95% CI, 2.76-5.85; P <.001) individuals and other race/ethnicity individuals (OR, 1.68; 95% CI, 1.02-2.77; P <.04) were more likely to request life-prolonging treatments vs non-Hispanic White persons.

The researchers noted that their study is subject to survey errors, and the estimates may be biased. Also, analyses of specific subgroups may be limited owing to sample-size limitations, and the survey is based on self-reported responses.

“Findings from this study highlight opportunities to promote completion of advanced care planning and ensuring the understanding of treatment preferences in individuals with HD [heart disease] as recommended practice, particularly among individuals from racial and ethnic minority groups,” wrote the study authors.