Abstract 4147288: Social determinants and healthcare utilization among adults with hypertrophic cardiomyopathy: data from the All of Us Research Program

Background: Individual-level social determinants of health (SDoH) and healthcare utilization (HCU) are understudied among adults with hypertrophic cardiomyopathy (HCM). Objective: To examine SDoH and HCU among adult participants in the All of Us Research Program, who have a diagnosis of HCM. Methods: We conducted a cross-sectional analysis All of Us Research Program data, overall, stratified by race and ethnicity, and by self-identified gender. Eligible individuals included those with an ICD-9, or ICD-10 diagnostic codes for HCM. We used chi square tests and t-tests to examine differences in SDoH and HCU among the study population. Results: The sample was N=1,110 (51% women, 21% non-Hispanic Black [NH] adults, 11% Hispanic adults, 39% with obstructive HCM). Median [interquartile range] was 69 years [59;77]. Seventeen percent had Medicaid, 38% among Hispanic adults, vs 35% among NH Black adults and 6.8% among NH White adults, p<0.001. Medicaid % was similar among women and men. The lowest education level (high school or below) was among Hispanic adults, 81%, vs 78% among NH Black adults, and 38% among NH White adults, p<0.001, and among women 56%, vs men, 46%, p<0.001. Seventy-nine percent of Black adults had a yearly income <$50,000, vs 73% among Hispanic adults, and 35% among NH White adults, p<0.001. Fifty-four percent of women had this income vs 41% of men, p<0.001. HCU data was available for 50% of the sample. There were no racial or ethnic differences related to usual place of care or number of health visits over the last year. However, 27% of NH Black adults reported not being able to afford their prescriptions, vs 11% among Hispanic adults, and 9.4% among NH White adults, p=0.003. Women were more likely to delay care due to work, 7.5% vs men, 2.9%, p=0.023, and caregiving responsibilities, 4.5%, vs men, 0.9%, p=0.032. Geospatial analysis found that most participants resided at least 28 miles away from an HCM specialty center. Conclusions: This analysis identified individual-level SDoH and HCU patterns among a diverse cohort of community-dwelling adults with HCM. Findings may inform future intervention targets and intervention strategies to improve access and care for individuals with HCM.