Determinants of Health and Outcomes in Medicare Recipients With Heart Disease: A Population Study

Kelley M Anderson; Edilma Yearwood; William S Weintraub; Yi Xia; Rebecca Scally; Hunter Groninger; Anirudh Rao; Jaeil Ahn

doi:10.1016/j.jpainsymman.2023.08.001

Determinants of Health and Outcomes in Medicare Recipients With Heart Disease: A Population Study

J Pain Symptom Manage. 2023 Nov;66(5):561-569.e2. doi: 10.1016/j.jpainsymman.2023.08.001. Epub 2023 Aug 6.

Authors

Kelley M Anderson¹, Edilma Yearwood², William S Weintraub³, Yi Xia⁴, Rebecca Scally², Hunter Groninger⁵, Anirudh Rao⁵, Jaeil Ahn⁴

Affiliations

¹ Georgetown University School of Nursing (K.M.A., E.Y., R.S.), Washington, District of Columbia. Electronic address: kma25@georgetown.edu.
² Georgetown University School of Nursing (K.M.A., E.Y., R.S.), Washington, District of Columbia.
³ MedStar Health Research Institute (W.S.W.), Hyattsville, Maryland; Georgetown University School of Medicine (W.S.W., H.G., A.R.), Washington, District of Columbia.
⁴ Department of Biostatistics, Bioinformatics, and Biomathematics (Y.X., J.A.), Georgetown University, Washington, District of Columbia.
⁵ Georgetown University School of Medicine (W.S.W., H.G., A.R.), Washington, District of Columbia; Section of Palliative Care (H.G., A.R.), MedStar Washington Hospital Center, Washington, District of Columbia.

PMID: 37544553
DOI: 10.1016/j.jpainsymman.2023.08.001

Abstract

Context: Heart disease (HD) is a primary cause of mortality and morbidity in the United States. While there is a growing body of evidence demonstrating the contribution of social determinants of health (SDoH) to HD outcomes, the impact of combined or individual SDoH on health-related quality of life (HRQoL) in patients with HD is not well understood.

Objectives: To analyze the National Health and Aging Trends Study (NHATS) to explore the relationship of SDoH with HRQoL, advance care planning, and treatment preferences in Medicare beneficiaries with HD.

Methods: The study design was a secondary data analysis using latent class analysis (LCA) and multivariable analysis of NHATS participants with HD, Round 8, that included End of Life Plans and Care questions.

Results: 1202 participants, median age 81 years, 57% female, 70% non-Hispanic White, 20% non-Hispanic Black, 10% Other. LCA identified two SDoH risk profiles (low/high), using 12 measures within the NHATS Economic and Social Consequences key concept area. The high-risk SDoH profile participants were more likely to have fair/poor HRQoL, and identify as female, non-White (P < 0.0001); and less likely to have completed advance care planning (P < 0.0001). High-risk SDoH participants were more likely to want life-prolonging treatments (P < 0.0001), however, this association was not significant after adjusting for age, sex, and race (P = 0.344).

Conclusion: Higher risk SDoH profiles are associated with reduced HRQoL, reduced advance care planning completion, female sex, and non-White race in a cohort of Medicare beneficiaries. These findings provide opportunities to improve SDoH-related care practices in older patients with HD.

Keywords: Social determinants of health; advance care planning; health related quality of life; heart disease; national health and aging trends study; treatment preferences.