Addressing Social Determinants of Health and Mitigating Health Disparities Across the Lifespan in Congenital Heart Disease: A Scientific Statement From the American Heart Association

Lopez, Keila N.; Baker‐Smith, Carissa M.; Flores, Glenn; Gurvitz, Michelle; Karamlou, Tara; Gallegos, Flora Nuñez; Pasquali, Sara K.; Patel, Angira; Peterson, Jennifer K.; Salemi, Jason L.; Yancy, Clyde W.; Peyvandi, Shabnam

doi:10.1161/jaha.122.025358

Cited by 72 publications

(54 citation statements)

References 107 publications

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“…5 Moreover, the persistence of hypertension for many individuals is a result of a failure in the implementation of antihypertensive strategies, which is a currently neglected facet of current classifications, particularly with respect to obstacles related to social determinants and structural racism. 23 In this study, we further elucidated a variety of patient concerns leading to why a treatment plan was not carried out, including obstacles to obtaining medications, psychosocial barriers, patient misunderstanding, and negative medication experience, which further demonstrated the need for personalized social interventions, but also that these needs could be identified via information existing in the EHR. As such, this actionable taxonomy provides a more comprehensive approach to classifying people by the mechanism of what prevents them from reaching BP targets.…”

Section: Discussionmentioning

confidence: 92%

Developing an Actionable Taxonomy of Persistent Hypertension Using Electronic Health Records

Khidir

et al. 2023

Circ: Cardiovascular Quality and Outcomes

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BACKGROUND: The digital transformation of medical data presents opportunities for novel approaches to manage patients with persistent hypertension. We sought to develop an actionable taxonomy of patients with persistent hypertension (defined as 5 or more consecutive measurements of blood pressure ≥160/100 mmHg over time) based on data from the electronic health records. METHODS: This qualitative study was a content analysis of clinician notes in the electronic health records of patients in the Yale New Haven Health System. Eligible patients were 18 to 85 years and had blood pressure ≥160/100 mmHg at 5 or more consecutive outpatient visits between January 1, 2013 and October 31, 2018. A total of 1664 patients met criteria, of which 200 records were randomly selected for chart review. Through a systematic, inductive approach, we developed a rubric to abstract data from the electronic health records and then analyzed the abstracted data qualitatively using conventional content analysis until saturation was reached. RESULTS: We reached saturation with 115 patients, who had a mean age of 68.1 (SD, 11.6) years; 54.8% were female; 52.2%, 30.4%, and 13.9% were White, Black, and Hispanic patients. We identified 3 content domains related to persistence of hypertension: (1) non-intensification of pharmacological treatment, defined as absence of antihypertensive treatment intensification in response to persistent severely elevated blood pressure; (2) non-implementation of prescribed treatment, defined as a documentation of provider recommending a specified treatment plan to address hypertension but treatment plan not being implemented; and (3) non-response to prescribed treatment, defined as clinician-acknowledged persistent hypertension despite documented effort to escalate existing pharmacologic agents and addition of additional pharmacologic agents with presumption of adherence. CONCLUSIONS: This study presents a novel actionable taxonomy for classifying patients with persistent hypertension by their contributing causes based on electronic health record data. These categories can be automated and linked to specific types of actions to address them.

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Section: Discussionmentioning

confidence: 92%

Developing an Actionable Taxonomy of Persistent Hypertension Using Electronic Health Records

Khidir

et al. 2023

Circ: Cardiovascular Quality and Outcomes

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“…This statement specifically encourages research using methods such as structural equation modeling to understand the complex interplay between multiple variables and factors. 20…”

Section: Discussionmentioning

confidence: 99%

“…This statement specifically encourages research using methods such as structural equation modeling to understand the complex interplay between multiple variables and factors. 20 Our socioeconomic position variable was based on individual level metrics including maternal education level and insurance status. In this study, the main driver was maternal education level and insurance status played a much smaller role.…”

Section: Discussionmentioning

confidence: 99%

Disparities in 1-Year-Mortality in Infants With Cyanotic Congenital Heart Disease: Insights From Contemporary National Data

Steurer-Muller

McCulloch

Santana

et al. 2023

Circ: Cardiovascular Quality and Outcomes

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BACKGROUND: Racial inequities in congenital heart disease (CHD) outcomes are well documented, but contributing factors warrant further investigation. We examined the interplay between race, socioeconomic position, and neonatal variables (prematurity and small for gestational age) on 1-year death in infants with CHD. We hypothesize that socioeconomic position mediates a significant part of observed racial disparities in CHD outcomes. METHODS: Linked birth/death files from the Natality database for all liveborn neonates in the United States were examined from 2014 to 2018. Infants with cyanotic CHD were identified. Non-Hispanic Black (NHB) and Hispanic infants were compared with non-Hispanic White (NHW) infants. The primary outcome was 1-year death. Socioeconomic position was defined as maternal education and insurance status. Variables included as mediators were prematurity, small for gestational age, and socioeconomic position. Structural equation modeling was used to calculate the contribution of each mediator to the disparity in 1-year death. RESULTS: We identified 7167 NHW, 1393 NHB, and 1920 Hispanic infants with cyanotic CHD. NHB race and Hispanic ethnicity were associated with increased 1-year death compared to NHW (OR, 1.43 [95% CI, 1.25–1.64] and 1.17 [95% CI, 1.03–1.33], respectively). The effect of socioeconomic position explained 28.2% (CI, 15.1–54.8) of the death disparity between NHB and NHW race and 100% (CI, 42.0–368) of the disparity between Hispanic and NHW. This was mainly driven by maternal education (21.3% [CI, 12.1–43.3] and 82.8% [CI, 33.1–317.8], respectively) while insurance status alone did not explain a significant percentage. The direct effect of race or ethnicity became nonsignificant: NHB versus NHW 43.1% (CI, −0.3 to 63.6) and Hispanic versus NHW −19.0% (CI, −329.4 to 45.3). CONCLUSIONS: Less privileged socioeconomic position, especially lower maternal education, explains a large portion of the 1-year death disparity in Black and Hispanic infants with CHD. These findings identify targets for social interventions to decrease racial disparities.

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“…Recent attention has been focused on the identification and amelioration of racial disparities within health care. 9,10 Accordingly, we sought to investigate the potential associations between racial and ethnic group membership and postoperative outcomes after ACF surgery. As a nationally validated data set with a substantial patient sample size and many participating member sites, the ACS-NSQIP was a useful tool for conducting this analysis.…”

Section: Discussion Study Findingsmentioning

confidence: 99%

Are There Racial and Ethnic Health Disparities Among Outcomes After Anterior Cranial Fossa Surgery? A Propensity Score-Matched American College of Surgeons National Surgical Quality Improvement Program Study

et al. 2023

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BACKGROUND: Race-based health care outcomes remain to be described in anterior cranial fossa (ACF) surgery. OBJECTIVE: To determine whether race predicts worse outcomes after ACF surgery. METHODS: A retrospective cohort study was performed using the American College of Surgeons National Surgical Quality Improvement Program data for 2005 to 2020. Current Procedural Terminology and International Classification of Diseases-9 codes were used to identify ACF tumor cases. Propensity score matching was performed to compare White and minority patients to assess the robustness of unmatched findings. A subanalysis of pituitary adenoma (PA) resections was also performed. RESULTS: In an unmatched analysis of 1370 patients who underwent ACF surgery (67.9% White, 17.4% Black, 6.6% Asian/ Pacific Islander, and 6.3% Hispanic), minority groups had higher rates of comorbidities. Unmatched multivariate analysis found Hispanic patients bore a 1.86 odds ratio (OR) of minor complications, Black and Asian and Pacific Islander patients bore 1.49 and 1.71 ORs, respectively, for extended length of stay, and Black patients bore a 3.78 OR for urinary tract infection (UTI). Matched analysis found that minority patients had higher UTI rates (P = .02) and a 4.11 OR of UTI. In PA cases specifically, minority groups had higher comorbidities and length of stay in addition to extended length of stay odds (1.84 OR). CONCLUSION: Although most ACF surgery outcomes were unaffected by race, minority groups had more minor postoperative complications than White patients, particularly UTI. Similar disparities were observed among PA cases. Higher rates of comorbidities may also have led to longer hospital stays. Further study is needed to understand what actions might be necessary to address any race-associated health disparities in ACF surgery.

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Addressing Social Determinants of Health and Mitigating Health Disparities Across the Lifespan in Congenital Heart Disease: A Scientific Statement From the American Heart Association

Cited by 72 publications

References 107 publications

Developing an Actionable Taxonomy of Persistent Hypertension Using Electronic Health Records

Developing an Actionable Taxonomy of Persistent Hypertension Using Electronic Health Records

Disparities in 1-Year-Mortality in Infants With Cyanotic Congenital Heart Disease: Insights From Contemporary National Data

Are There Racial and Ethnic Health Disparities Among Outcomes After Anterior Cranial Fossa Surgery? A Propensity Score-Matched American College of Surgeons National Surgical Quality Improvement Program Study

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