Income, food security correlate to use of COVID-19 mitigation practices in CVD
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Individuals with CVD and greater burden regarding social determinants of health were less likely to practice COVID-19 risk mitigation measures such as personal protection and social distancing, a speaker reported.
According to data presented at the virtual American College of Cardiology Scientific Session, greater social determinants of health burden were also associated with less work flexibility such as working from home and canceling or postponing work.
“Our study assessed risk mitigation practices among patients with CVD in the early-to-middle phase of the pandemic, a period when compliance relevant to the eventual epidemic size is influenced by the perception of risk and existing trust between health care systems and the public,” Kobina Hagan, MBChB, MPH, postdoctoral fellow at the Center for Outcomes Research at Houston Methodist, told Healio. “Health care systems with better integration of social services into clinical care may be favorably placed to engender appropriate patient compliance with mitigation recommendations. We believe that cardiac clinics should collaborate with patients and support social services to identify the health-related social needs of their clients, so they can have strategies in place to deliver services, including culturally responsive health messaging to the most vulnerable during public health emergencies.”
The study was simultaneously published in Circulation: Cardiovascular Quality and Outcomes.
The researchers used the National Opinion Research Center’s COVID Impact Survey to evaluate the relationship between social determinants of health burden and COVID-19 risk mitigation practices. Social determinants of health burden were measured using variables including education, insurance, economic stability, food security, urbanicity, neighborhood quality and social integration. The researchers evaluated COVID-19 risk mitigation practices such as masking; hand hygiene; physical distancing; social distancing; and work flexibility, defined as working from home and canceling/postponing work.
This study included 25,279 U.S. adults, of whom 7% reported underlying CVD. According to the study, this cohort was representative of 8.69 million adults residing in 18 U.S. geographic areas. Participants were stratified into quartiles by social determinants of health burden.
“As a caveat, the survey did not assess the drivers or reasons for nonadherence. However, we can have a guided deliberation on some drivers of nonadherence to the safety measures based on this study and previous studies,” Hagan told Healio. “Opportunities to cancel or postpone work schedules and telecommute depend on the nature of work and the availability of telecommunication infrastructure and are typically beyond the control of people. For measures that somewhat curtail liberties and require personal choices like masking, and avoiding crowds and public places, the perception of risk and existing trust in the health system and policymakers are key to compliance, especially within minority and socially vulnerable populations.”
A majority of participants with CVD were aged 60 years or younger (68%), men (54%), white (67%) and insured (96%). Among adults with CVD, 35% had the greatest social determinants of health burden and more than half reported total household income of less than $50,000 in 2019.
Researchers reported that adults with the greatest social determinates of health burden reported less engagement in all measures of personal protection (89% vs. 75.6%), social distancing (58.9% vs. 41.9%) and less working from home or canceling/postponing work (41.4% vs. 26.2%) compared with adults with the lowest burden.
After adjustment, the highest social determinate of health burden was associated with lower likelihood adherence to all measures of personal protection (prevalence ratio [PR] = 0.83; 95% CI, 0.73-0.96; P = .009), lower likelihood of adhering to social distancing measures (PR = 0.69; 95% CI, 0.51-0.94; P = .018) and lower likelihood of having a flexible work schedule (PR = 0.53; 95% CI, 0.36-0.79; P = .002).
Researchers reported a linear dose-response relationship between social determinants of health and work flexibility (P = .003).
“So far, health care players have done quite well in maintaining awareness of the importance of these mitigation measures. However, more can be done for patients with cardiovascular disease and accompanying social vulnerability,” Hagan told Healio. “There should be a proactive process to identify individuals with adverse social circumstances who may be at risk of health misinformation. The pandemic is evolving with the emergence of new coronavirus variants and vaccination. The methodologic evidence on the importance of these mitigation measures at all phases of the pandemic must be effectively communicated to such vulnerable groups. Strong patient-provider relations and trusted community partners should be utilized to aid in community education.”
Reference:
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Hagan K, et al. Prevention and health promotion: Population science 1. Presented at: American College of Cardiology Scientific Session; May 15-17, 2021 (virtual meeting).
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