Neighborhood Leading SDOH Affecting COVID, Health Outcomes

According to an American Heart Association study, patients who live within socially vulnerable neighborhoods have a higher likelihood of high complications from COVID-19 infections, offering insight into neighborhood factors being a critical social determinant of health (SDOH).

In addition, patients from disadvantaged neighborhoods also had higher rates of death and cardiovascular disease.

The researchers used health data from the American Heart Association’s COVID-19 Cardiovascular Disease Registry, with information regarding 20,000 hospitalized COVID-19 patients between January and November 2020. This data included patients with and without a history of cardiovascular disease.

The data was used to conclude if a patient’s neighborhood social vulnerability impacted their cardiac outcomes. Researchers used the US Centers for Disease Control & Prevention’s (CDC's) Social Vulnerability Index (SVI) scale to rank neighborhood's social vulnerability based on 15 factors including, socioeconomic status, household composition and disability, race/ethnic group and primary language with the household, and housing type and transportation.

The research revealed that hospitalized COVID-19 patients in the most socially vulnerable neighborhoods had a greater likelihood of in-hospital death and cardiovascular events regardless of their preexisting health conditions.

“Unfortunately, I’m not surprised by the findings of this research. Getting into the why, how, and which social factors are most consequential in affecting health and then putting our patients in contact with the resources to help them are key for health care professionals,” Michelle A. Albert, MD, MPH, FAHA, president-elect of the American Heart Association, publicly stated.

About 40 percent of patients lived in neighborhoods that ranked within the highest quartile of SVI, meaning comparatively, they experienced deeper levels of poverty and higher levels of insufficient housing as well as transportation. Additionally, the study found that COVID patients living in areas with the highest SVI independently associated with a higher risk of having a cardiac event.

“It is widely known that an individual’s neighborhood of residence impacts their health,” Shabatun Islam, MD, lead author of the study and a cardiology fellow at Emory University School of Medicine in Atlanta, said in statement

“As physicians, it’s important for us to recognize that people living in vulnerable neighborhoods often experience high rates of adverse health outcomes even when everything else may be the same,” Islam continued. Additionally, it is important to strive to provide each patient with the resources and support to improve overall health and health outcomes. It is not always clear what specifically may be the most helpful to help support our patients, so this is definitely an area where future research is needed.”

Addressing this issue, and other health disparities like it, will require deep community health partnership and culture changes in medicine, Albert said.

“Addressing health disparities is going to take a multi-pronged approach of societal solutions, such as building community relationships, increasing diversity in the health care workforce, and strengthening research funding and clinical care focused on social factors and their impact on health,” Albert concluded.