Social Vulnerability Index and Cardiovascular Disease Care Continuum: A Scoping Review

SGLT2 inhibitors and cardiovascular outcomes in patients with left ventricular assist devices

INTRODUCTION

Left ventricular assist devices (LVADs) provide critical support for patients with advanced heart failure (HF), but complications and suboptimal outcomes remain challenges. Sodium-glucose cotransporter 2 (SGLT2) inhibitors have shown promise in HF, but their role in patients with LVADs is not well established. We aimed to evaluate the association of SGLT2 inhibitors with clinical outcomes and heart transplantation rates in patients with LVADs.

METHODS

We conducted a retrospective cohort study using the TriNetX Network (2014-2022) to identify all adults (≥18 years old) with LVADs. Patients were stratified into SGLT2 inhibitor users and non-users during LVAD-supported period. Propensity score matching (1:1, PSM) was performed to balance baseline characteristics between two cohorts. Efficacy outcomes included all-cause mortality/hospitalization, HF exacerbations, acute myocardial infarction, cerebral infarction, cardiac arrest, and heart transplant. Safety outcomes included acute kidney injury (AKI), urinary tract infection (UTI), and urogenital candidiasis. Adjusted odds ratios (aORs) with 95 % confidence intervals (CIs) were calculated.

RESULTS

Among 3736 patients with LVADs, 1106 received SGLT2 inhibitors from 2014 to 2022. After PSM, 656 patients were included in each group. SGLT2 inhibitor use was associated with lower risks of all-cause mortality [0.571 (95 % CI, 0.430-0.759)], all-cause hospitalization [aOR 0.619 (0.478-0.802)], acute HF exacerbations [aOR 0.687 (0.539-0.877)], cerebral infarction [aOR 0.676 (0.501-0.912)], and cardiac arrest [aOR 0.441 (0.269-0.725)]. No significant differences were observed for heart transplantation rates [aOR 1.084 (0.834-1.408)] or acute MI [aOR 0.881 (0.663-1.172)]. Safety outcomes favored SGLT2 inhibitor cohort with lower risks of AKI [aOR 0.767 (0.617-0.954)], with no significant difference for UTI [aOR 0.730 (0.527-1.012)] or urogenital candidiasis [aOR 1.000 (0.413-2.419)].

CONCLUSIONS

SGLT2 inhibitor use in LVAD-supported patients was associated with improved survival, reduced hospitalizations and heart failure exacerbation alongside favorable safety outcomes. These findings support further investigation into SGLT2 inhibitors as a potential adjunctive therapy in the management of patients with LVADs.

County-Level Urbanization and Cardiovascular Death in Patients With Cancer

CONTEXT

Cardiovascular death (CVD) is a leading cause of mortality in patients with cancer, with sociodemographic factors such as urbanization influencing outcomes.

OBJECTIVE

To examine the impact of county-level urbanization on CVD mortality in patients with cancer in the United States from 1999 to 2020.

DESIGN

Retrospective cross-sectional analysis using CDC WONDER mortality data.

SETTING

US counties categorized as rural or urban based on the 2013 NCHS Urban-Rural Classification Scheme.

PARTICIPANTS

Patients with cardiovascular disease (ICD-10: I00-I78) and comorbid cancer (ICD-10: C00-C97), spanning all U.S. counties from 1999 to 2020.

MAIN OUTCOME MEASURES

Age-adjusted mortality rates (AAMRs) per 100 000 population and rural-to-urban rate ratios (RRs) with 95% confidence intervals.

RESULTS

The cumulative rural-to-urban RR for CVD in patients with cancer was 1.11 (95% CI: 1.10-1.11), increasing from 1.00 in 1999 to 1.20 in 2020 (β = 0.009, P < .001). Rural AAMRs were higher across demographic groups, including males (12.85 vs 11.62 per 100 000), females (6.08 vs 5.58), Black individuals (9.76 vs 9.64), and White individuals (8.79 vs 7.94). Rural Black populations showed a rising RR from 0.85 in 1999 to 1.04 in 2020 (β = 0.005, P = .01). Hispanic populations exhibited lower rural mortality, with a stable RR (0.93, P = 1.0). The most common CVD cause was ischemic heart disease (53.93% of rural and 55.9% of urban deaths).

CONCLUSIONS

An increasing rural-to-urban disparity in CVD mortality among cancer patients highlights the role of urbanization in health inequities. Interventions targeting rural health care access and socioeconomic disparities are essential to address this growing gap.

Demographic Factors and Aortic Stenosis-Related Death Locations: A Cross-Sectional Analysis

Background: Aortic stenosis (AS) imposes a significant mortality burden. Understanding demographic influences on the location of AS-related death is crucial for advancing equitable end-of-life care. Therefore, we investigated how demographic factors influence the location of death among AS patients in the United States. Methods: We completed a cross-sectional study utilizing US mortality data from the CDC's WONDER database for 2019. All files related to decedents with AS identified as the primary cause of death were obtained, including demographic information and death locations (i.e., inpatient facilities, outpatient/ER facilities, home, or hospice/nursing facilities). Associations between demographic factors (age, sex, race/ethnicity, marital status, and education) and place of death were assessed using multivariable logistic regression models, yielding odds ratios (ORs). Results: In 2019, most AS-related deaths occurred in inpatient facilities (38.3%, n = 5062), home (29.2%, n = 3859), or hospice/nursing facilities (28.6%, n = 3775). Higher odds of inpatient death were observed among Black (OR 1.67, p < 0.001) and Hispanic individuals (OR 1.91, p < 0.001) compared to White decedents. Those aged >85 years were more likely to die at home (OR 1.76, p < 0.001) or in hospice/nursing facilities (OR 7.80, p < 0.001). Males had increased odds of inpatient death (OR 1.09, p = 0.044) but decreased odds of hospice/nursing facility death (OR 0.87, p = 0.003). Higher education levels were associated with increased odds of home death (OR 1.33, p = 0.023) and decreased odds of hospice/nursing facility death (OR 0.71, p = 0.015). Conclusions: Demographic factors significantly influence the location of death among AS patients, emphasizing the need for culturally and socioeconomically tailored interventions to promote equitable end-of-life care.

Burden of Hyperlipidemia, Cardiovascular Mortality, and COVID-19: A Retrospective-Cohort Analysis of US Data

BACKGROUND

Hyperlipidemia is a major cardiovascular disease (CVD) risk factor, but there are limited data on its mortality trends in CVD over time. We assessed annual hyperlipidemia-related CVD mortality trends in the United States, including the COVID-19 pandemic's impact.

METHODS AND RESULTS

Mortality data were obtained from the Centers for Disease Control and Prevention repository between 1999 and 2020 among patients ≥15 years old, using International Classification of Diseases, Tenth Revision (ICD-10) codes for hyperlipidemia (E78.0-E78.5) and CVD (I00-I99). Age-adjusted mortality rates (AAMRs) per 1 000 000 population were standardized to the 2000 US population. Log-linear regression models were used to evaluate mortality shifts. Average annual percentage change from 1999 to 2019 was used to project 2020 AAMRs, estimating pandemic-attributed excess deaths. From 1999 to 2020, 483 155 hyperlipidemia-related CVD deaths occurred. Despite a general CVD mortality decline, hyperlipidemia-related CVD AAMRs rose from 36.33 in 1999 to 99.77 in 2019. Ischemic heart diseases (AAMR 49.39) were the leading cause, whereas hypertension had the highest mortality increase (average annual percentage change +10.23%). Mortality rates were higher in men (AAMR 104.87) and non-Hispanic (AAMR 82.49), and rural populations (AAMR 89.98). Highest mortality was observed in Black populations (AAMR 84.35), those ≥75 years old (AAMR 646.45), and Western US regions (AAMR 96.88). During the first pandemic year, deaths exceeded projections by 10.55%, with notable increases among ages 35 to 75 (14.23%), Hispanic (17.96%), Black (14.82%), and urban (11.68%) groups.

CONCLUSIONS

Hyperlipidemia-related CVD mortality has risen over the past 2 decades, further heightened by the COVID-19 pandemic, with higher impact on men, Black Americans, the older population, and rural residents. Further study is needed to understand contributing factors and mitigate disparities.

Disparities in cardiac arrest mortality among patients with chronic kidney disease: A US-based epidemiological analysis

Background

Chronic kidney disease (CKD) increases cardiac arrest (CA) risk because of renal and cardiovascular interactions.

Methods

Using Centers for Disease Control and Prevention (CDC) data from 1999 to 2020, we analyzed CKD-related CA mortality and the impact of social vulnerability index (SVI).

Results

We identified 336 494 CKD-related CA deaths, with stable age-adjusted mortality rates over time. Disparities were observed across gender, racial/ethnic, and geographic subpopulations, with higher mortality among males, Hispanic and non-Hispanic Black populations, and those in urban and Western regions. Higher SVI correlated with increased mortality.

Conclusions

CKD-related CA mortality rates are stable, with disparities across demographics; higher SVI correlates with increased mortality, highlighting needed interventions.

The association between neighborhood social vulnerability and community-based rehabilitation after stroke

BACKGROUND

Timely rehabilitative care is vital for functional recovery after stroke. Social determinants may influence access to and use of post-stroke care but have been inadequately explored. The study examined the relationship between the Social Vulnerability Index (SVI) and community-based rehabilitation utilization.

METHODS

We included 6,843 adults (51.6% female; 75.1% White; mean age 70.1) discharged home after a stroke enrolled in the COMprehensive Post-Acute Stroke Services study, a pragmatic trial conducted in 40 North Carolina hospitals from 2016-2019. Rehabilitation utilization was sourced from administrative claims. Geocoded addresses were linked to 2018 Census tract SVI. Associations between SVI and 90-day rehabilitation use, adjusted for patient's clinical and socio-economic characteristics, were obtained from generalized estimating equations. We also examined the associations of SVI with therapy setting, types of therapy, intensity of visits, and time to first visit.

RESULTS

Thirty-five percent of patients had at least one physical (PT) or occupational therapy (OT) visit within 90 days, ranging from 32.4%-38.7% across SVI quintiles. In adjusted analysis, there was no dose-reponse relationship between higher summary SVI, nor most of its sub-domains, and 90-day rehabilitation use. Greater vulnerability in household composition and disability was modestly associated with -0.4% (95% CI -4.1% to 3.4%) to -4.3% (95% CI -0.8% to -7.7%) lower rehabilitation use across SVI quartiles. Greater summary and subdomain SVI was associated with higher odds of receiving therapy in the home versus outpatient clinic (OR = 1.88, 1.58 to 2.17 for Q5 vs Q1 summary SVI) and receiving both PT and OT versus a single-type therapy (1.72, 1.48 to 1.97 for Q5 vs. Q1 summary SVI). No differences were observed for therapy intensity or time to therapy.

CONCLUSION

Use of rehabilitation care was low, and largely similar across levels of SVI and most of its subdomains. Individuals residing in areas of high SVI were more likely to receive therapy in the home and to receive dual therapy, possibly reflecting greater need among these individuals. Future studies should evaluate potential mechanisms for these findings and further identify both patient and community factors that may inform strategies to improve rehabilitation use.

CLINICAL TRIAL NUMBER

https://www.

CLINICALTRIALS

gov/ NCT02588664 [registration date: 2015-10-23].

Lung cancer mortality trends and disparities: A cross-sectional analysis 1999-2020

BACKGROUND

Lung cancer remains a leading cause of morbidity and mortality in the United States. Given the importance of epidemiological insight on lung cancer outcomes as the foundation for targeted interventions, we aimed to examine lung cancer death trends in the United States in the recent 22-year period, exploring demographic disparities and yearly mortality shifts.

METHODS

Mortality information was obtained from the CDC Wide-ranging Online Data for Epidemiologic Research database from the years 1999-2020. Demographic information included age, sex, race or ethnicity, and area of residence. We performed log-linear regression models to assess temporal mortality shifts and calculated average annual percentage change (AAPC) and compared age-adjusted mortality rates (AAMR) across demographic subpopulations.

RESULTS

A total of 3,380,830 lung cancer deaths were identified. The AAMR decreased from 55.4 in 1999-31.8 in 2020 (p<0.001). Males (AAMR 57.6) and non-Hispanic (NH) (AAMR 47.5) populations were disproportionately impacted compared to females (AAMR 36.0) and Hispanic (AAMR 19.1) populations, respectively. NH Black populations had the highest AAMR (48.5) despite an overall reduction in lung cancer deaths (AAPC -3.3 %) over the study period. Although non-metropolitan regions were affected by higher mortality rates, the annual decrease in mortality among metropolitan regions (AAPC -2.8 %, p<0.001) was greater compared to non-metropolitan regions (AAPC -1.7 %, p<0.001). Individuals living in the Western US (AAPC -3.4 %, p<0.001) experienced the greatest decline in lung cancer mortality compared to other US census regions.

CONCLUSIONS

Our findings revealed lung cancer mortality inequalities in the US. By contextualizing these mortality shifts, we provide a larger framework of data-driven initiatives for societal and health policy changes for improving access to care, minimizing healthcare inequalities, and improving outcomes.

Social Vulnerability Index and All-Cause Mortality After Acute Ischemic Stroke, Medicare Cohort 2020-2023

Background

Inequities in stroke outcomes have existed for decades, and the COVID-19 pandemic amplified these inequities.

Objectives

This study examined the association between social vulnerability and all-cause mortality among Medicare beneficiaries hospitalized with acute ischemic stroke (AIS) during COVID-19 pandemic periods.

Methods

We analyzed data on Medicare fee-for-service beneficiaries aged ≥65 years hospitalized with AIS between April 1, 2020, and December 31, 2021 (followed until December 31, 2023) merged with county-level data from the 2020 Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry's Social Vulnerability Index (SVI). We used a Cox proportional hazard model to examine the association between SVI quartile and all-cause mortality.

Results

Among 176,123 Medicare fee-for-service beneficiaries with AIS, 29.9% resided in the most vulnerable counties (SVI quartile 4), while 14.9% resided in counties with least social vulnerability (SVI quartile 1). AIS Medicare beneficiaries living in the most vulnerable counties had the highest proportions of adults aged 65 to 74 years, non-Hispanic Black or Hispanic, severe stroke at admission, a history of COVID-19, and more prevalent comorbidities. Compared to those living in least vulnerable counties, AIS Medicare beneficiaries living in most vulnerable counties had significantly higher all-cause mortality (adjusted HR: 1.11, 95% CI: 1.08-1.14). The pattern of association was largely consistent in subgroup analyses by age group, sex, and race and ethnicity.

Conclusions

Higher social vulnerability levels were associated with increased all-cause mortality among AIS Medicare beneficiaries. To improve outcomes and address disparities, it may be important to focus efforts toward addressing social vulnerability.