Causal Association of Social Determinants of Health and Dynamic Impact on Mortality in Patients with Chronic Heart Failure

Abstract

Purpose The causality between social determinants of health (SDoH) and mortality in patients with chronic heart failure (CHF) is uncertain. Herein, we assessed the causality using inverse probability weighting (IPW) of marginal structural models (MSMs) during the course of CHF. Method A multicenter, prospective cohort study of 1377 patients with CHF were enrolled from September 2017. The social domain and two dimensions of Chronic Heart Failure Patient-Reported Outcomes Measure (CHF-PROM) was used to assess the SDoH, social support, and support utilization of patients with CHF. CHF-PROM and mortality information were obtained at 1, 3, and 6 months following patient discharge, and every 6 months thereafter at regular follow-ups. Logistic regression and IPW of MSMs were applied to analyze the SDoH, social support, and support utilization on mortality in patients with CHF. Results Logistic regression showed that at baseline, the SDoH, social support, and support utilization were not associated with mortality in patients with CHF. After adjusting for confounders, MSMs showed that the SDoH and social support were not associated with mortality at baseline. In contrast, low support utilization at baseline and unfavorable SDoH, low social support, and low support utilization during follow-up increased the risk of death in patients with CHF. Conclusion Through follow-up data and MSMs analysis, we found that the long-term out-of-hospital causal effects, but not one-time effects of SDoH, are risk factors for CHF mortality. SDoH should be taken seriously during the entire CHF process to prolong patients’ survival. Trial registration: The cohort number registered in the China Clinical Trial Registry is ChiCTR2100043337. URL: https://www.chictr.org.cn/showproj.html?proj=64980 Registered on February 11, 2021