■健康的不良社会决定因素(SDoH)与心脏代谢疾病有关;然而,心脏代谢结果的差异很少是单一危险因素的结果.
■本研究旨在基于来自机构电子病历的患者报告和社区水平数据来识别和表征SDoH表型,并评估糖尿病的患病率,肥胖,和其他心脏代谢疾病的表型状态。
■收集了患者报告的SDoH(2020年1月至12月)和邻里级的社会脆弱性,邻里社会经济地位,和乡村通过人口普查与地理编码的患者地址相关联。使用国际疾病分类代码将糖尿病状态编码在电子病历中;使用测量的BMI≥30kg/m2定义肥胖。潜在类别分析用于识别SDoH的簇(例如,表型);然后,我们使用患病率比(PR)根据表型状态检查了心脏代谢疾病患病率的差异。
■完整数据可用于分析2380例患者(平均年龄53,SD16岁;n=1405,59%为女性;n=1198,50%为非白人)。大约8%(n=179)报告住房不安全,30%(n=710)报告了资源需求(食物,卫生保健,或公用事业),49%(n=1158)生活在高度脆弱的人口普查区。我们确定了3例患者的SDoH表型:(1)高社会风险,主要由自我报告的SDoH定义(n=217,9%);(2)不利邻域SDoH(n=1353,56%),主要由不利的邻里水平措施定义;和(3)低社会风险(n=810,34%),定义为低个人和社区级别的风险。具有不良邻域SDoH表型的患者诊断为2型糖尿病的患病率较高(PR1.19,95%CI1.06-1.33),高血压(PR1.14,95%CI1.02-1.27),外周血管疾病(PR1.46,95%CI1.09-1.97),和心力衰竭(PR1.46,95%CI1.20-1.79)。
■与个体水平特征确定的表型相比,具有不良邻域SDoH表型的患者具有较高的不良心脏代谢疾病患病率,表明邻里环境起作用,即使个人的社会经济地位衡量标准不是次优的。
UNASSIGNED: Adverse social determinants of health (SDoH) have been associated with cardiometabolic disease; however, disparities in cardiometabolic outcomes are rarely the result of a single risk factor.
UNASSIGNED: This study aimed to identify and characterize SDoH
phenotypes based on patient-reported and neighborhood-level data from the institutional electronic medical record and evaluate the prevalence of diabetes, obesity, and other cardiometabolic diseases by phenotype status.
UNASSIGNED: Patient-reported SDoH were collected (January to December 2020) and neighborhood-level social vulnerability, neighborhood socioeconomic status, and rurality were linked via census tract to geocoded patient addresses. Diabetes status was coded in the electronic medical record using International Classification of Diseases codes; obesity was defined using measured BMI ≥30 kg/m2. Latent class analysis was used to identify clusters of SDoH (eg,
phenotypes); we then examined differences in the prevalence of cardiometabolic conditions based on phenotype status using prevalence ratios (PRs).
UNASSIGNED: Complete data were available for analysis for 2380 patients (mean age 53, SD 16 years; n=1405, 59% female; n=1198, 50% non-White). Roughly 8% (n=179) reported housing insecurity, 30% (n=710) reported resource needs (food, health care, or utilities), and 49% (n=1158) lived in a high-vulnerability census tract. We identified 3 patient SDoH
phenotypes: (1) high social risk, defined largely by self-reported SDoH (n=217, 9%); (2) adverse neighborhood SDoH (n=1353, 56%), defined largely by adverse neighborhood-level measures; and (3) low social risk (n=810, 34%), defined as low individual- and neighborhood-level risks. Patients with an adverse neighborhood SDoH phenotype had higher prevalence of diagnosed type 2 diabetes (PR 1.19, 95% CI 1.06-1.33), hypertension (PR 1.14, 95% CI 1.02-1.27), peripheral vascular disease (PR 1.46, 95% CI 1.09-1.97), and heart failure (PR 1.46, 95% CI 1.20-1.79).
UNASSIGNED: Patients with the adverse neighborhood SDoH phenotype had higher prevalence of poor cardiometabolic conditions compared to
phenotypes determined by individual-level characteristics, suggesting that neighborhood environment plays a role, even if individual measures of socioeconomic status are not suboptimal.