Abstract 14134: Associations of Social Determinants of Health With Pulmonary Hypertension Severity and Reported Quality of Life

Abstract

Introduction: Though the chronic, progressive disease Pulmonary Hypertension (PH) has no known cure, timely and appropriate treatment can improve outcomes. Social determinants of health (SDH) may influence treatment accessibility and outcomes. We hypothesized that Social Vulnerability Index (SVI) and Hardship Index (HDX, i.e., living in a zip code of higher hardship) are associated with measures of PH severity and quality of life (QoL). Methods: Patients at UI Health aged ≥18 years, diagnosed with PH from 2017-2021, and with EmPHasis-10 QoL scores and residence zip code data were included. SDH included Social Vulnerability Index (SVI) and Hardship Index (HDX). Income was retrieved from 2019 US Census data and most recent socio-behavioral data from the Chicago Health Atlas. Multivariate and logistic regression analysis were performed using SAS. Results: In 58 patients, mean age was 58 (SD 13.5), 47 (81.0%) were women, and 42 (72.4%) were non-Hispanic black. In this cohort, the uninsured rate showed a significant positive correlation with tricuspid regurgitant velocity on echocardiogram (p = 0.048) and, as SVI increased, there was a trend toward higher right atrial pressure (p = 0.07). Unexpectedly, there was a trend toward lower EmPHasis 10 scores (indicating better reported QoL) in subjects with worse SVI or HDX. When examining this further, a modified EmPHasis 10 QoL score focused on rest, exhaustion, and energy showed a significant inverse correlation of QoL with either SVI or HDX (p = .025 and p = .045, respectively). Conclusions: SDH appear to be associated with measures of PH severity. These findings suggest that SDH may negatively impact disease, which will need to be tested in a longitudinal study. The inverse correlation of SVI and HDX with QoL, particularly when focusing on personal experience, was unexpected. In theory, perceived norms and cultural context in high hardship, socially vulnerable communities may alter patient perception of disease impact on QoL. Future analysis should focus on further characterization of patient experiences in diverse populations with PH to ensure that we have accurate tools and are addressing the needs of our diverse community.