Disproportionate Burden of Cardiovascular-Kidney-Metabolic Factors in Patients with Adverse SDOH

There is a disproportionate burden of cardiovascular-kidney-metabolic (CKM) factors in patients with adverse social determinants of health (SDOH), explained Tiffany Powell-Wiley, MD, MPH, FAHA, FABMR, chief of Social Determinants of Obesity and Cardiovascular Risk Laboratory, Division of Intramural Research, NHLBI, and adjunct investigator of the Intramural Research Program, NIMHD, during a session at the American Heart Association (AHA) Scientific Sessions 2023 in Philadelphia, Pennsylvania.

Powell-Wiley elaborated further by noting that SDOH can be related to both socioeconomic and environmental factors; however, there are more intermediary determinants that are related to social risks, the lived experiences of the individual as a result are psychological and biological. These social influences eventually impact the health of these individuals, and in some communities, there are more adverse social determinants than others.

“…we know that Black and Hispanic patients are more likely to have diabetes and complications from diabetes, [and] kidney disease and kidney failure also disproportionately affect these communities,” said Powell-Wiley during the session. “And we also know that there are many communities where we need more data—particularly in indigenous, Pacific Islanders, [and] Asian communities—in terms of how social determinants influence CKM health.”

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SDOH are particularly influential to CKM health due to adverse, multiple-level determinants impacting health factors that drive the development of CKM factors. Further, adverse SDOH may increase the likelihood of development and detection of risk factors, disease complications, cardiovascular disease events, and mortality in individuals with pre-existing CKM factors. Access to therapeutic options to support CKM health is limited among certain populations, and navigating health systems with multiple providers and therapies can be particularly challenging for these individuals.

“…these social determinants really have an effect on the access to numerous therapeutic options—including GLP1 receptor agonists—particularly for those who are living in areas of high social deprivation. And so, as we develop this framework around CKM health, we really want to take a social ecological approach and think about how do we incorporate not only social determinants in the screening, risk prediction, the algorithms developed, but also the composition of the care teams who are implementing treatments for CKM syndrome,” said Powell-Wiley during the session.

Powell-Wiley continued to explain how social ecological framework can be utilized to consider the types of social determinants that should be addressed across the individual, community, and environmental levels. In terms of screening for SDOH and addressing CKM syndrome, the focus should be on screening throughout the patient’s life for their individuals SDOH and social needs, in addition to screening as patients progress through different stages of CKM syndrome. Integrating assessments into health care can be done through electronic health records and with help from community health care workers who can help patients access, self-manage, and navigate social needs resources.

Further, it is important to consider how leveraging existing community resources can help identify available resources to address social aid while also maintaining access to those resources. Currently, screening tools take social demographics—income, education, food security, and housing stability—as well as financial strain and transportation challenges into consideration. Powell-Wiley provides several examples of screening tools that have been incorporated into the electronic health record, such as the Health Leads tool which improves blood pressure and low-density lipoprotein cholesterol in both clinical settings and when resources are provided to address social needs, and the Centers for Medicare and Medicaid Services’s tool that reduces ER visits by screening and providing appropriate social need services.

Currently, approximately 70% of hospitals in the United States screen for at least 1 health-related social need, whereas 60% are screening and utilizing strategies to address at least 1 social need. Additionally, only 20% to 25% of hospitals screen for 8 or more social needs, indicating room for further development when addressing social needs as part of the care progress for patients with CKM syndrome.

Further, recent research demonstrates that participation and value-based care programs predict the screening and utilization of social resources and partnerships with community-based organizations. In addition, recent content mapping to better understand the areas that needed to be addressed further was performed.

“[This content mapping helped] address…what to do in social needs screening,” said Powell-Wiley during the session. “Big questions [included] which social needs are critical for a health system to address, or must they all be addressed simultaneously for health improvement? And then to what extent does health system partnerships with community-based organizations resolve social needs and lead to health improvement?”

Powell-Wiley suggested that future work in this field can focus on patient-centered approaches and addressing CKM health to address patients’ social needs while improving outcomes, quality of life, and screening social determinants in patients. She also noted that future tools can also expand to include health literacy and mental health when screening.

“More work needs to go into leveraging existing community resources and programs, and help working with health care systems to create the infrastructure to connect patients to these community-based organizations that can provide resources around SDOH,” said Powell-Wiley during the session.

Reference

Powell-Wiley, T. More Therapies, Less Equity? Addressing Access and Disparities in Cardiovascular-Kidney-Metabolic Health. AHA Scientific Sessions 2023 Main Event. Presented at: AHA Scientific Sessions 2023; November 12, 2023.