Abstract 4146287: Social Determinants of Health: Impact on Mortality and Care Status for Adults with Congenital Heart Disease

Introduction: Social determinants of health (SDOH) impact health outcomes for adults with congenital heart disease (CHD). We sought to understand how SDOH impacted access to care and mortality in adults with CHD. Methods: Electronic health records were queried across 13 PCORnet clinical sites to identify adults with CHD (CHI-RON study). Those with moderate or complex CHD lesion types were included in the current analyses. Social deprivation index (SDI), our predictor, was calculated using zip code scores (0-100) and were categorized into quintiles (from least to most deprived). Out of care status was defined as no cardiology visit for >2 years (complex CHD) or 3 years (moderate CHD) as of 2/28/20. Only centers with > 90% positive predictive value on care status validation were included in the care status analysis. Mortality was confirmed through the National Death Index. Multivariable logistic regression assessed the association between SDI and outcomes (mortality, care status) with fixed effects for CHD complexity, age, sex, and random effects for sites. Results: Our cohort included 20495 patients with a median age of 33 years (range: 23-48), 50% with moderate CHD, 50% male, 10.3% non-Hispanic Black, 13.2% Hispanic, and 42% urban. Of 5916 included in the care status analysis, 41.7% were out of care. Higher (worse) SDI scores had greater odds of being out of care, with the greatest risk in the highly (OR 1.3, CI: 1.1-1.6, p< 0.001) and most deprived (OR 1.4, CI: 1.2-1.7, p<0.001) communities. SDI factors most associated with being out of care included regions with lower educational attainment (OR 1.6, CI: 1.4-1.8, p<0.001), lower vehicle (OR 1.5, CI 1.4-1.7, p<0.001) or home (OR 1.7, CI 1.5-2.0, p<0.001) ownership, and higher unemployment (OR 1.8, CI 1.5-2.2, p<0.001). Mortality rate was ~3% (n=618). Factors associated with higher odds of mortality included: living in highly deprived (OR 1.7, CI: 1.3-2.1, p<0.01) or most deprived (OR 1.6, CI: 1.2-2.1, p< 0.01) communities, Black (OR: 1.9; CI: 1.5-2.3, p<0.01) or Hispanic (OR: 1.6; CI: 1.2-2.1, p<0.01) race and ethnicity, and living in rural areas (OR: 2.0; CI 1.5-2.6, p<0.001). Conclusions: Adults with CHD living in areas with higher SDI scores may be at greater risk for not receiving recommended cardiology care and mortality; Black, Hispanic, and rural ACHD patients may be at higher risk for mortality. Further study is needed to understand how social and systemic drivers intersect with race to impact CHD.