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Social Vulnerability and Long-Term Cardiovascular Outcomes After COVID-19 Hospitalization: An Analysis of the
Reza Fakhraei1, Yang Song1, Dhruv S Kazi1
1Richard A. and Susan F. Smith Center for Outcomes Research Beth Israel Deaconess Medical Center, and Harvard Medical School Boston MA USA.
Insights
Patient-level social vulnerability, but not county-level, increased cardiovascular events after COVID-19 hospitalization, primarily due to comorbidities. Public health efforts should focus on dual-eligible patients for better outcomes.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- Patients hospitalized with COVID-19 from socioeconomically vulnerable communities face risks for in-hospital cardiovascular events.
- The association between socioeconomic vulnerability and post-hospitalization outcomes remains uncertain.
Purpose of the Study:
- To evaluate the association between socioeconomic vulnerability and cardiovascular events after COVID-19 hospitalization.
- To investigate the impact of patient-level and county-level social vulnerability on post-discharge cardiovascular outcomes.
Main Methods:
- Analysis of American Heart Association COVID-19 Cardiovascular Disease Registry hospitalizations linked with Medicare claims (March 2020-June 2022).
- Utilized the Social Vulnerability Index for county-level and Medicare-Medicaid dual eligibility for patient-level vulnerability assessment.
- Cox regression models assessed the association between social vulnerability and a composite of myocardial infarction, stroke, heart failure, venous thromboembolism, cardiogenic shock, cardiac arrest, and death.
Main Results:
- No association was found between the most vulnerable counties and cardiovascular events (HR, 0.97).
- Dual eligibility was initially associated with increased cardiovascular events (HR, 1.28), but this association was attenuated after adjusting for comorbidities (HR, 0.97).
- Patients with higher social vulnerability were more likely to be female, Black or Hispanic, and have increased comorbidities.
Conclusions:
- Patient-level social vulnerability, particularly dual eligibility, is linked to cardiovascular events post-COVID-19 hospitalization, largely explained by comorbidities.
- County-level social vulnerability did not show a significant association with post-discharge events.
- Public health interventions should target dual-eligible patients to mitigate adverse cardiovascular outcomes following COVID-19 hospitalization.
Background:
Patients hospitalized with COVID-19 from socioeconomically vulnerable communities are at risk for in-hospital cardiovascular events. However, the association of socioeconomic vulnerability and outcomes after hospitalization is uncertain.
Methods And Results:
American Heart Association COVID-19 Cardiovascular Disease Registry hospitalizations between March 1, 2020, and June 30, 2022, linked with Medicare fee-for-service claims, were analyzed. We used Centers for Disease Control and Prevention's Social Vulnerability Index to ascertain county-level and Medicare-Medicaid dual eligibility to ascertain patient-level social vulnerability. We evaluated the association between social vulnerability and a composite of myocardial infarction, stroke, heart failure, venous thromboembolism, cardiogenic shock, cardiac arrest, and death, following discharge, using Cox regression models. The study included 8565 patients (mean age 78 years, 50% female, 16% Black, 4% Hispanic, 25% dual eligible, 34% residing in the most vulnerable counties). Patients residing in the most vulnerable counties, and dual eligible patients, were more likely to be female, Black or Hispanic, and have increased comorbidities. A total of 3783 (52%) patients experienced a composite outcome. We found no association between the most vulnerable, compared with least vulnerable, counties and cardiovascular events (hazard ratio [HR], 0.97 [95% CI, 0.87-1.07]). Dual eligibility, compared with nondual eligibility, was associated with increased cardiovascular events (HR, 1.28 [95% CI, 1.19-1.37]), which was attenuated after adjusting for comorbidities (HR, 0.97 [95% CI, 0.89-1.04]).
Conclusions:
Among survivors of COVID-19 hospitalization, patient-level social vulnerability was associated with cardiovascular events, explained by increased comorbidities. County-level social vulnerability was not observed to be a risk for postdischarge events. Findings suggest targeting public health efforts toward dual eligible patients to mitigate poor outcomes.
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