Multiple Social Determinants Of Health Research Articles

Post-9/11 veterans perceptions of the pandemic: Areas of greatest impact on health and well-being.

Assess potential impacts of the COVID-19 pandemic on a subset of Post-9/11 U.S. Veterans included in a study of post-traumatic epilepsy (PTE). Two measures were added to a structured health interview for Veterans during temporary pandemic research shutdown: a validated health questionnaire [1] previously completed by survey, and a semi-structured instrument developed to assess whether pandemic conditions affected responses to the health questionnaire and identify unique impacts. Interviews were conducted between August 2020 - February 2021. Scaled items were calculated and t-tests used to compare results. Open-ended items were coded using thematic analyses. Veterans identified eight major areas of impact with negative and positive impacts: mental health, family, social, work/employment, access to resources, physical health, finances, and education. The temporary shut-down of a large health study for Post-9/11 Veterans provided an opportunity to devise an instrument to assess COVID-19's impact on health and well-being. The instrument was accepted as of the first Veteran instrument in a pandemic SDOH research repository [2], and is being used in other studies. This study highlights the need to assess and understand interrelated relationships of factors impacting health and well-being, especially as COVID-19 moves from pandemic to endemic with reverberating effects across multiple social determinants of health (SDOH).

Exploring the challenges and prospects of healthcare reporting in India's Hinterland

Differential access and utilisation of healthcare services are caused by multiple Social Determinants of Health (SDHs), which requires adequate and informed policy intervention. The mass media, mainly the news media, have been seen as a practical approach in communicating the health anomalies at the policy level. The comprehensive coverage of factors associated with the healthcare system can further lead to addressing inequalities in health. The study was aimed to identify the factors that act against effective reporting of healthcare news from peripheral regions of India. The qualitative method was employed to examine media professionals' persistent challenges and experiences in covering health-related disparities. Sixteen media professionals were interviewed during October 2019 employed in vernacular news agencies all across the north-eastern state of Assam, India. Three themes have emerged from the analysis covering health-related news and barriers to healthcare in the peripheral region and identifying health-related disparities. It is found that an effective reporting mechanism of the health news will positively influence the policymakers and undertake efforts to address the health-related disparities.

Quitting Smoking before and after Pregnancy: Study Methods and Baseline Data from a Prospective Cohort Study.

Smoking during pregnancy and postpartum remains an important public health problem. No known prior study has prospectively examined mutual changes in risk factors and women’s smoking trajectory across pregnancy and postpartum. The objective of this study was to report methods used to implement a prospective cohort (Msgs4Moms), present participant baseline characteristics, and compare our sample characteristics to pregnant women from national birth record data. The cohort study was designed to investigate smoking patterns, variables related to tobacco use and abstinence, and tobacco treatment quality across pregnancy through 1-year postpartum. Current smokers or recent quitters were recruited from obstetrics clinics. Analyses included Chi-square and independent sample t-tests using Cohen’s d. A total of 62 participants (41 smokers and 21 quitters) were enrolled. Participants were Black (45.2%), White (35.5%), and multiracial (19.3%); 46.8% had post-secondary education; and most were Medicaid-insured (64.5%). Compared with quitters, fewer smokers were employed (65.9 vs 90.5%, Cohen’s d = 0.88) and more reported financial strain (61.1% vs 28.6%; Cohen’s d = 0.75). Women who continue to smoke during pregnancy cope with multiple social determinants of health. Longitudinal data from this cohort provide intensive data to identify treatment gaps, critical time points, and potential psychosocial variables warranting intervention.

Exploring the intersection of multiple social determinants of health and disordered eating behaviors in a population-based sample in the United States.

Disordered eating behaviors (DEBs) have long-term, deleterious effects on health and are more prevalent among socially marginalized groups, likely as a result of systemic inequities across social determinants of health (SDoH). This exploratory study aimed to identify subgroups of emerging adults characterized by main and interactive associations between SDoH and two forms of DEB (binge eating, extreme unhealthy weight control behaviors). Participants (n=1568; age 22.2 ± 2.1 years) from the United States were drawn from the EAT 2010-2018 longitudinal study. Conditional inference tree (CIT) analyses derived main and intersecting SDoH related to DEB across 33 input variables collected during adolescence and emerging adulthood. The binge eating CIT revealed five subgroups (prevalence: 6.3-23.2%) shaped by variables collected during emerging adulthood: appearance-based teasing (p < .001), financial difficulty (p=.003), gender (p < .001), and everyday discrimination (p=.008). The CIT results for extreme unhealthy weight control behaviors derived six subgroups (prevalence: 2.3-45.5%) shaped by weight teasing (p < .001) and gender (p < .001) during emerging adulthood and public assistance (p=.008) and neighborhood safety (p=.007) in adolescence. This exploratory study revealed distinct subgroups of emerging adults with varying DEB prevalence, suggesting that variability in DEB prevalence may be partially explained by intersecting SDoH during adolescence and emerging adulthood. Hypothesis-driven research and replication studies are needed to further explore the associations between SDoH and DEB during emerging adulthood. Disordered eating behaviors are common among young people in the United States and have long-term health consequences. This exploratory study identified subgroups of young people, characterized by combinations of social inequities (e.g., financial difficulties, teasing). Results highlight high-risk subgroups of emerging adults that should be examined further in hypothesis-driven research.

Distinct outcomes in Hispanic/Latinx and non-Hispanic/Latinx patients with metastatic renal cell carcinoma (mRCC) treated with first-line ipilimumab plus nivolumab (ipi/nivo).

4554 Background: Subgroup analyses have reported differences in clinical outcomes by ethnicity in patients (pts) receiving immune checkpoint inhibitors (Cheng et al Ann Oncol 2019; Peravali et al World J Clin Oncol 2021). We sought to compare real-world outcomes between Hispanic/Latinx and non-Hispanic/Latinx mRCC pts treated with first-line ipi/nivo within a safety-net healthcare system and at a tertiary care center in Southern California. Methods: We performed a retrospective analysis of mRCC pts who received ipi/nivo within the Los Angeles County Department of Health Services (a safety-net healthcare system) and the City of Hope Comprehensive Cancer Center (a tertiary oncology center) between Jan 1, 2015 and Dec 31, 2021. Pts were identified using institutional databases and clinical data were compiled from electronic health records. Pts with pathologic diagnosis of stage IV mRCC, age &gt; 18 years and receipt of ipi/nivo as first-line therapy were included. Progression-free survival (PFS) was analyzed using the Kaplan-Meier method and covariates were adjusted using multivariate Cox proportional hazards regression. Results: Of 96 pts, 67 (70%) were male, 90 (94%) had clear-cell histology, and 89 (93%) had intermediate/poor IMDC risk. Forty-two pts (44%) were Hispanic/Latinx while the remainder were non-Hispanic/Latinx (44 pts [46%] White, 7 pts [7%] Asian, and 3 pts [3%] Other). Fifty (52%) and 46 (48%) pts received their care at a tertiary care center and within a safety-net healthcare system, respectively. Median age, IMDC risk classification, BMI, and number of comorbidities were similar between both groups. Pooled analysis by ethnicity revealed significantly shorter PFS in Hispanic/Latinx vs non-Hispanic/Latinx pts (HR 1.60, 95% CI 1.04-2.48, p = 0.03). At 12 months, 19% of Hispanic/Latinx pts (95% CI, 9-32) and 35% of non-Hispanic/Latinx pts (95% CI, 23-48) were alive and progression-free. There was no difference in PFS between pts at the safety-net hospital system vs tertiary care center (HR 1.32, 95% CI 0.87-2.02, p = 0.19). Conclusions: Our real-world analysis of mRCC pts demonstrated poorer outcomes with ipi/nivo in Hispanic/Latinx pts. We are currently interrogating multiple social determinants of health that may contribute to these concerning disparities.

PD25-01 SOCIAL DETERMINANTS OF HEALTH AND OVERACTIVE BLADDER IN A LARGE NATIONWIDE CROSS-SECTIONAL STUDY

You have accessJournal of UrologyCME1 May 2022PD25-01 SOCIAL DETERMINANTS OF HEALTH AND OVERACTIVE BLADDER IN A LARGE NATIONWIDE CROSS-SECTIONAL STUDY Elisabeth Sebesta, Stephanie Gleicher, Melissa Kaufman, Roger Dmochowski, and W. Stuart Reynolds Elisabeth SebestaElisabeth Sebesta More articles by this author , Stephanie GleicherStephanie Gleicher More articles by this author , Melissa KaufmanMelissa Kaufman More articles by this author , Roger DmochowskiRoger Dmochowski More articles by this author , and W. Stuart ReynoldsW. Stuart Reynolds More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002567.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There is growing interest in how social determinants of health (SDOH) may explain relationships between social conditions and health. Overactive bladder (OAB) is common in the United States, posing a significant public health burden. Previously, lower socioeconomic status has been associated with more severe urge urinary incontinence (UUI). Most recently, a multicenter cross-sectional study demonstrated a link between certain SDOH and OAB severity in women in an urban setting. It was the goal of the present study to assess whether OAB was associated with unmet social needs in a large nationwide cross-sectional sample of patients. METHODS: A community-based sample of adult patients was recruited electronically to complete questionnaires on clinical and demographic information, urinary symptoms (LURN SI-10 and ICIQ-SF UI), and social needs. Excluded patients were currently pregnant, with history of cystectomy or neurologic lower urinary tract dysfunction. Variables were assessed with multivariable logistic regression. RESULTS: A total of 3,673 patients were included for analysis, with a mean age of 40.7±17.3 years. The majority of patients identified as white, non-Hispanic (84.0%) and female (77.1%). Of all patients, 1,485 (40.4%) were classified as having OAB (UUI in a 7-day period and/or urgency with frequency >8 times/day). The presence of OAB was associated with numerous unmet social needs, including worry about a stable/safe place to live, food insecurity, worry about utilities, lack of transportation, skipping medical appointments, needing legal help, stress in personal relationships, worry about a place to urinate at home, stress about home plumbing, and lack of social supports (Table). On multivariable analysis adjusting for age, gender, race, BMI, parity, and history of pelvic radiation or surgeries, all associations between OAB and SDOH remained significant. CONCLUSIONS: In this large nationwide sample, multiple SDOH were associated with the presence of OAB, which may have implications on the overall management of OAB patients. As providers it is important to consider these unmet social needs of patients, and suggests a role for collaboration with social workers and/or mental health providers in order to offer OAB patients with the best and most comprehensive care. Source of Funding: UL1 TR000445 from NCATS/NIH © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e421 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Elisabeth Sebesta More articles by this author Stephanie Gleicher More articles by this author Melissa Kaufman More articles by this author Roger Dmochowski More articles by this author W. Stuart Reynolds More articles by this author Expand All Advertisement PDF DownloadLoading ...

State-Level Social Vulnerability Index and Healthcare Access: The Behavioral Risk Factor Surveillance System Survey

Access to health care is affected by social determinants of health. The social vulnerability index encompasses multiple social determinants of health simultaneously and may therefore be associated with healthcare access. Cross-sectional data were used from the 2016‒2019 Behavioral Risk Factor Surveillance System, a nationally representative U.S. telephone-based survey of adults aged ≥18 years. State-level social vulnerability index was derived using county-level social vulnerability index estimates from the Centers for Disease Control and Prevention Agency for Toxic Substances and Disease Registry. Analyses were performed in October 2021. Social vulnerability index was ranked according to percentiles, which were divided into tertiles: Tertile 1 (0.10-0.32), Tertile 2 (0.33-0.53), and Tertile 3 (0.54-0.90). In multivariable-adjusted models comparing U.S. states in Tertile 3 with those in Tertile 1 of social vulnerability index, there was a higher prevalence of absence of healthcare coverage (OR=1.39 [95% CI=1.22, 1.58]), absence of primary care provider (OR=1.34 [95% CI=1.22, 1.48]), >1-year duration since last routine checkup (OR=1.18 [95% CI=1.10, 1.27]), inability to see a doctor because of cost (OR=1.38 [95% CI=1.23, 1.54]), and the composite variable of any difficulty in accessing healthcare (OR=1.15 [95% CI=1.08, 1.22]). State-level social vulnerability is associated with several measures related to healthcare access. These results can help to identify targeted interventions to improve access to health care in U.S. states with high social vulnerability index burden.

Perspectives of Black Immigrant Women on Mental Health: The Role of Stigma.

Background:Black immigrants are a major growing segment of the United States population. The intersection of race, gender, and migration places black immigrant women at the confluence of multiple social determinants of health, and thus, black immigrant women experience ongoing mental health disparities. Understanding their perspectives, mental health needs, and associated stigma is critical to promoting positive mental health outcomes.Methods:We conducted five focus groups (N = 22) among women from two black immigrant community organizations from February 2019 to June 2019. We used an inductive driven thematic analysis to identify codes and themes related to mental health and the role of stigma.Results:Overall five core themes associated with mental health and associated stigma concepts were found: The critical role of trusted sources and confidentiality, Conceptualization of mental illness and anticipated discrimination, Acculturative influence and migration as a source of emotional distress, Spirituality as a source of support and source of stigma, and Management of mental illness and addressing stigma.Conclusion:The conceptualization of mental illness and the associated stigma may be rooted in cultural and religious belief systems among black immigrants. Cultural beliefs and biopsychosocial models can coexist positively without interrupting the pathway toward optimized engagement in mental health care. Our mental health systems need to take these factors into consideration to implement programs that effectively serve black immigrant women's mental health needs.

A Qualitative Study on the Social Determinants of HIV Treatment Engagement Among Black Older Women Living With HIV in the Southeastern United States.

Black older women living with HIV (BOWLH) in the United States are disproportionately affected by HIV infection and poor treatment engagement rates, often caused by multiple social determinants of health. In this descriptive qualitative study, we interviewed 17 BOWLH to investigate the facilitators and barriers to HIV treatment engagement. Data were analyzed using the socioecological framework. Findings demonstrate the positive influences of supportive social networks, perceived benefits, HIV-related knowledge, raising HIV awareness in communities, and impact of HIV state laws. The highlighted barriers were mainly low income, substance use, HIV-related stigma, influence of stereotypes and assumptions about older women living with HIV, and health insurance. Religion, managing comorbidities, attitude toward, HIV disclosure, and caregiving roles had both positive and negative influences on engagement. These findings illuminate factors of HIV treatment engagement that might be culturally founded; disseminating these factors to health care professionals is a critical intervention to support this population.

A county-level analysis of unemployment and mental health in the Southeastern U.S.: applying a social determinants of health framework

ABSTRACT Informed by a Social Determinants of Health framework, this study examines associations between county-level unemployment rates and two county-level indicators of mental health challenges. With 2017 data from County Health Rankings, the study focuses on 418 counties in the southeastern U.S., a region with longstanding unmet service needs and ongoing mental health care challenges. Linear regression models show positive associations between unemployment and two county-level indicators of mental health challenges, while accounting for multiple social determinants of health. The study illustrates how county-level analysis can help social workers target mental health needs and increase access to care.

Disparities in Guideline-Concordant Treatment and Survival Among Border County Residents With Gastric Cancer.

Previous studies have shown health disparities among US-Mexico border county (BC) residents. However, the impact of BC residence on gastric cancer treatment and survival outcomes is unknown. Our study compares the receipt of guideline-concordant care (GCC) and survival for patients with gastric cancer by BC status. We conducted a retrospective review of adult non-Hispanic White and Hispanic patients with gastric adenocarcinoma diagnosed between 2004 and 2017 in the Texas Cancer Registry. Chi-square tests were used to compare categorical group differences, with pooled t-tests used to compare group means. The impact of BC residence on likelihood of receiving GCC was assessed with logistic regression. Overall survival was estimated using the Kaplan-Meier method and compared with log-rank tests. Our cohort consisted of 12,514 patients (15% BC). Overall, 45% of nonborder county residents received GCC versus 35% of BC residents (P < .0001). After adjusting for age, race, stage, and insurance status, BC patients remained significantly less likely to receive GCC (odds ratio 0.69; 95% CI, 0.61 to 0.78). BC residence was associated with increased hazard of all-cause mortality after accounting for age, race, stage, poverty index, and treatment receipt (hazard ratio 1.11; 95% CI, 1.04 to 1.18). BC residents had significantly worse overall survival for localized and regional disease. BC residents with gastric cancer are less likely to receive GCC and have significantly worse survival outcomes than nonborder county residents. This highlights significant health care disparities arising from the lack of health care access and multiple social determinants of health. Further studies are needed to identify specific contributing mechanisms to improve health care equity.

Social Determinants of Health and Depression among African American Adults: A Scoping Review of Current Research.

Depression in the United States (US) is increasing across all races and ethnicities and is attributed to multiple social determinants of health (SDOH). For members of historically marginalized races and ethnicities, depression is often underreported and undertreated, and can present as more severe. Limited research explores multiple SDOH and depression among African American adults in the US. Guided by Healthy People (HP) 2030, and using cross-disciplinary mental health terminology, we conducted a comprehensive search to capture studies specific to African American adults in the US published after 2016. We applied known scoping review methodology and followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. From 12,315 initial results, 60 studies were included in our final sample. Most studies explored the HP 2030 Social and Community Context domain, with a heavy focus on discrimination and social support; no studies examined Health Care Access and Quality. Researchers typically utilized cross-sectional, secondary datasets; no qualitative studies were included. We recommend research that comprehensively examines mental health risk and protective factors over the life course within, not just between, populations to inform tailored health promotion and public policy interventions for improving SDOH and reducing racial and ethnic health disparities.

Acculturation in context: The relationship between acculturation and socioenvironmental factors with level of and change in cognition in older Latinos

AbstractBackgroundLatinos are 1.5 times as likely to develop Alzheimer’s dementia as non‐Latino Whites. This health disparity may arise from multiple influences with culturally‐relevant factors receiving increasing attention. Models of acculturation stress the importance of considering acculturation‐related factors within the context of socioenvironmental factors to better capture the Latino experience in the US.MethodWe measured 10 acculturation and contextually‐related variables in 199 Latinos (age∼69.7yrs) without dementia participating in Rush Alzheimer’s Disease Center studies. We subjected these variables to Principal Component Analysis (PCA) to study their interrelationships; then investigated how the resulting components associated with level of and longitudinal change in domain‐specific cognition using separate linear mixed effects models adjusted for relevant confounders and their interactions with time.ResultThe PCA revealed a 3‐factor unrotated solution (variance explained ∼70%). Factor 1, representing acculturation‐related aspects of nativity, language‐ and social‐based acculturation, was positively associated with level, but not change, in semantic memory and perceptual speed. Factor 2, representing contextually‐related socioenvironmental experiences of discrimination, social isolation, and social networks, was associated with lower levels of episodic memory and working memory and faster longitudinal decline in visuospatial ability (Figure 1). Factor 3 (familism only) did not associate with level or change in any cognitive outcome. We are actively investigating the role of cardiovascular health on these associations.ConclusionAcculturation‐ and contextually‐related factors differentiated from each other and differentially contributed to cognition and cognitive decline in older Latinos. Providers should query multiple social determinants of health when evaluating older Latinos including acculturation‐ and contextually‐related lived experiences.

The Differential Contribution of Adverse Childhood Experiences and Perceived Discrimination on Substance Use among Hispanic Emerging Adults

ABSTRACT Adverse childhood experiences (ACE) are widely documented risk factors for substance use among Hispanic emerging adults. Studies seldom examine whether distinct ACEs differentially relate to substance use in emerging adulthood, and if said association varies in the context of additional stressors disproportionately experienced by Hispanic people. This examination is necessary for understanding the etiology of substance use disorders and related outcomes among Hispanic individuals. Using a sample of Hispanic emerging adults, the goals of this study were two-fold. First, it examined differences in substance use between subgroups of varying ACEs. Second, it assessed whether substance use in the presence of discrimination differed between ACE subgroups. Latent class analysis identified two emerging ACE subgroups: [1] Parental Separation and [2] Physical & Emotional. On average, individuals in the Physical & Emotional subgroup endorsed a higher likelihood of tobacco, cannabis, and illegal drug use than those in the Parental Separation subgroup. For the latter, the likelihood of binge drinking was higher than that of the Physical & Emotional subgroup if they also perceived discrimination in emerging adulthood. These findings highlight the importance of considering the intersection of multiple social determinants of health for understanding the lifetime risk of substance use among Hispanic individuals.

Public Health Impacts of Underemployment and Unemployment in the United States: Exploring Perceptions, Gaps and Opportunities.

Background: Unemployment, underemployment, and the quality of work are national occupational health risk factors that drive critical national problems; however, to date, there have been no systematic efforts to document the public health impact of this situation. Methods: An environmental scan was conducted to explore the root causes and health impacts of underemployment and unemployment and highlight multilevel perspectives and factors in the landscape of underemployment and unemployment. Methods: included a review of gray literature and research literature, followed by key informant interviews with nine organizational representatives in employment research and policy, workforce development, and industry to assess perceived needs and gaps in practice. Results: Evidence highlights the complex nature of underemployment and unemployment, with multiple macro-level underlying drivers, including the changing nature of work, a dynamic labor market, inadequate enforcement of labor protection standards, declining unions, wage depression, and weak political will interacting with multiple social determinants of health. Empirical literature on unemployment and physical, mental, and psychological well-being, substance abuse, depression in young adults, and suicides is quite extensive; however, there are limited data on the impacts of underemployment on worker health and well-being. Additionally, organizations do not routinely consider health outcomes as they relate to their work in workforce or policy development. Discussion and Conclusions: Several gaps in data and research will need to be addressed in order to assess the full magnitude of the public health burden of underemployment and unemployment. Public health needs to champion a research and practice agenda in partnership with multisector stakeholders to illuminate the role of employment quality and status in closing the gap on health inequities, and to integrate workforce health and well-being into labor and economic development agendas across government agencies and industry.

Social Determinants of Health Influencing the New Zealand COVID-19 Response and Recovery: A Scoping Review and Causal Loop Diagram

The Coronavirus pandemic of 2019–20 (COVID-19) affected multiple social determinants of health (SDH) across the globe, including in New Zealand, exacerbating health inequities. Understanding these system dynamics can support decision making for the pandemic response and recovery measures. This study combined a scoping review with a causal loop diagram to further understanding of the connections between SDH, pandemic measures, and both short- and long-term outcomes in New Zealand. The causal loop diagram showed the reinforcing nature of structural SDH, such as colonization and socio-economic influences, on health inequities. While balancing actions taken by government eliminated COVID-19, the diagram showed that existing structural SDH inequities could increase health inequities in the longer term, unless the opportunity is taken for socio-economic policies to be reset. Such policy resets would be difficult to implement, as they are at odds with the current socio-economic system. The causal loop diagram highlighted that SDH significantly influenced the dynamics of the COVID-19 impact and response, pointing to a need for purposeful systemic action to disrupt the reinforcing loops which increase health inequities over time. This will require strong systems leadership, and coordination between policy makers and implementation at local level.

The Impact of COVID-19 on Diverse Older Adults and Health Equity in the United States.

Older adults are most at risk of negative COVID-19 outcomes and consequences. This study applies the World Health Organization's Health Inequity Causal Model to identify different factors that may be driving the higher observed hospitalizations and deaths among older adults of color compared to non-Latinx Whites in the United States. We used multiple data sets, including the US Census American Community Survey and PULSE COVID data, along with published reports, to understand the social context of older adults, including income distributions by race and ethnicity, household composition and potential COVID-19 exposure to older adults by working family members. Our findings point to multiple social determinants of health, beyond individual health risks, which may explain why older adults of color are the most at risk of negative COVID-19 outcomes and consequences. Current health policies do not adequately address disproportionate impact; some even worsen it. This manuscript provides new data and analysis to support the call for equity-focused solutions to this pandemic and health in general in the future, focusing on meeting the needs of our most vulnerable communities.

Optimism, Resilience, and Other Health-Protective Factors Among Students During the COVID-19 Pandemic

Black, Indigenous, and People of Color (BIPOC) suffer disproportionately from coronavirus-related illness, death, and financial loss. The aim of this retrospective, qualitative study was to better understand the experiences of BIPOC students at a Bronx-based public university during the COVID-19 pandemic. Data was collected from a reflective final exam in a health sciences course in May 2020. Responses (n = 28) were coded and analyzed using the Social Determinants of Health (SDH) framework. Several themes were identified in structural and intermediary determinant areas, including occupation, education, social cohesion, and psychosocial factors. Participants demonstrated optimism, resilience, and perseverance—protective factors against exposure to adverse SDH. Findings indicate that COVID-19 negatively impacted BIPOC students in multiple SDH areas which may have a compounding effect, hindering equity and justice. Providers of social and academic support are critical levers in addressing SDH barriers and helping students strengthen protective factors to reduce adverse impacts of health-damaging determinants.

Subgroups of High-Risk Veterans Affairs Patients Based on Social Determinants of Health Predict Risk of Future Hospitalization.

Population segmentation has been recognized as a foundational step to help tailor interventions. Prior studies have predominantly identified subgroups based on diagnoses. In this study, we identify clinically coherent subgroups using social determinants of health (SDH) measures collected from Veterans at high risk of hospitalization or death. SDH measures were obtained for 4684 Veterans at high risk of hospitalization through mail survey. Eleven self-report measures known to impact hospitalization and amenable to intervention were chosen a priori by the study team to identify subgroups through latent class analysis. Associations between subgroups and demographic and comorbidity characteristics were calculated through multinomial logistic regression. Odds of 180-day hospitalization were compared across subgroups through logistic regression. Five subgroups of high-risk patients emerged-those with: minimal SDH vulnerabilities (8% hospitalized), poor/fair health with few SDH vulnerabilities (12% hospitalized), social isolation (10% hospitalized), multiple SDH vulnerabilities (12% hospitalized), and multiple SDH vulnerabilities without food or medication insecurity (10% hospitalized). In logistic regression, the "multiple SDH vulnerabilities" subgroup had greater odds of 180-day hospitalization than did the "minimal SDH vulnerabilities" reference subgroup (odds ratio: 1.53, 95% confidence interval: 1.09-2.14). Self-reported SDH measures can identify meaningful subgroups that may be used to offer tailored interventions to reduce their risk of hospitalization and other adverse events.

Abstract 14087: Psychosocial Determinants of Health Predict Depressive Symptoms and Anxiety in Rural Caregivers

Introduction: Caregivers have an 82% increased risk of cardiovascular disease (CVD) compared to non-caregivers. Depressive symptoms (DS) and anxiety increase CVD risk, and these are worse in rural dwellers. Knowing predictors of DS and anxiety in rural caregivers of patients with chronic illness is important to reduce CVD risk. Purpose: To identify predictors of DS and anxiety in rural caregivers at risk for CVD using a social determinants of health (SDH) model. Method: In this cross-sectional study we measured multiple SDH. These variables included sociodemographic (i.e., age, gender, race, marital status, health insurance, education, financial status), behavioral (i.e., smoking and body mass index [BMI]), and psychosocial (i.e., caregiver burden measured by the Zarit Burden Interview, perceived stress by the Cohen Perceived Stress Scale, and social support by the Medical Outcomes Study Social Support Survey) factors. The outcomes of DS were measured by the Patient Health Questionnaire-9 and anxiety by the Brief Symptom Inventory – Anxiety subscale. Data were analyzed using two separate multiple regression models, one for DS and one for anxiety. As depression and anxiety are often comorbid, they were considered predictors in the appropriate models. Results: In the 262 participants (mean age 53±13, 78% female, 96% Caucasian, 70% were married), mean years of education were 14±2, 56.1% had enough money to make ends meet, and 55% had no insurance or Medicaid only. Significant predictors of worse DS were higher caregiver burden (β=0.05, p=0.004), higher perceived stress (β=2.04, p=0.001), and higher anxiety (β=3.79, p= &lt;0.001). Predictors of worse anxiety, were younger age (β=-0.006, p=0.03), higher caregiver burden (β=0.006, p=0.009), lower social support (β=-0.004, p=0.05), and higher DS (β=0.08, p=&lt;0.001). Conclusion: Predictors of DS and anxiety in these rural caregivers were psychosocial variables. Caregiver CVD Interventions could be optimized by including stress management, education about the psychological effects of caregiving, and social support components. Future research is needed on the role of DS and anxiety in CVD to better support rural caregivers at highest risk.