Abstract 11590: Impact of Adverse Social and Behavioral Determinants of Health on In-Hospital Mortality Following an Acute Atherosclerotic Vascular Event at a Safety Net Community Hospital

Abstract

Introduction: Safety net community hospitals (SNCH) care for patients with disproportionately high prevalence of adverse social and behavioral determinants of health (SBDH). We evaluated the impact of adverse SBDH on in-hospital mortality and 30-days readmission after a first atherosclerotic cardiovascular disease (ASCVD) event at a large urban SNCH. Methods: We performed a retrospective review of patients presenting with an ASCVD event (coronary heart disease, cerebrovascular disease, or peripheral artery disease) between 2015 and 2019. Adverse SBDH was defined as history of homelessness, mental illness, incarceration, or substance use disorder. We used logistic regression analysis to evaluate independent predictors of in-hospital mortality and 30-day readmission following ASCVD event. Results: A cohort of 1974 patients was identified, mean age 63.8 years with standard deviation (SD) of 14.5, patients with adverse SBDH were 8 years younger than those without any adverse SBDH (58.5 years,SD:12 vs. 66 years,SD:14.8; p<0.0001). Atleast one adverse SBDH was noted in 28% of the cohort. Using multivariable analysis, presence of SBDH was not an independent predictor of in-hospital mortality or 30-day readmission following ASCVD event. Age above 65 years tripled the likelihood of in-hospital mortality. Black race and age above 45 years were independent predictors of 30-days readmission. Patients on aspirin and antihypertensives prior to admission were less likely to die in the hospital (Table 1). Conclusions: In this cohort from a SCNH with 28% prevalence of adverse SBDH, the presence of any adverse SBDH did not impact in-hospital mortality or 30-day readmission. However, notably, patients with adverse SBDH presenting with an index ASCVD event were about a decade younger than those without adverse SBDH.