Social Determinants of Health and Outcomes in Transthyretin Amyloid Cardiomyopathy

Transthyretin amyloid cardiomyopathy (ATTR-CM) is notoriously associated with delayed diagnosis and treatment barriers. Factors such as social determinants of health (SDOH) and race may have impacts on clinical outcomes. We sought to examine the impacts of SDOH and Black versus White race on clinical outcomes in ATTR-CM using a large national administrative claims dataset. We performed a retrospective cohort study in TriNetX of adults diagnosed with ATTR-CM from 2015 to 2023, identifying those with or without diagnosis codes for high-risk SDOH (ICD-10-CM Z55-65), which capture adverse conditions related to education, employment, housing, and economic instability. The cohort was further stratified by self-identified Black or White race. Propensity score matching of demographics and comorbidities was performed for between-group analyzes. The primary endpoint was a composite of all-cause mortality and hospitalization. Three-year event-free survival was estimated with Kaplan-Meier curves, and multivariable Cox proportional hazards models were used to examine between-group events. In total, 22,303 patients with ATTR-CM were identified, of whom 1,874 (8.4%) had diagnostic codes associated with high-risk SDOH. After propensity score matching, patients with high-risk SDOH had worse event-free survival compared to patients with low-risk SDOH (log-rank Chi-square = 92.611, p < 0.001), with high-risk SDOH being the among the strongest independent predictors of adverse outcomes (hazard ratio = 1.498, 95% confidence intervals [1.411 to 1.591], p < 0.001). Among patients with high-risk SDOH, similar event rates were observed between Black and White patients (log-rank Chi-square = 2.944, p = 0.139). However, in those with low-risk SDOH, Black patients experienced significantly worse event-free survival (log-rank Chi-square = 46.793, p < 0.001). In conclusion, among patients with ATTR-CM, diagnostic codes for high-risk SDOH were associated with worse clinical outcomes.