Abstract 117: Presence of Mental Health Disorders, Low Socioeconomic Status, More Closely Associated With Adverse Cardiovascular Outcomes After a Recent Hospitalization

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Abstract

Background: BRIDGE is a cardiac transitional care program. In previous studies, lower socioeconomic status (SES) and mental health disorders (MHD) have been associated with higher readmission rates. No research has been done on the combined effects of low SES and MHD on outcomes. This study sought to describe outcomes (ED Visits, readmission, and death) of patients by SES and MHD.

Methods: All patients referred to BRIDGE between 2008-2015 were included in this study. Data were analyzed in three ways: 1) by SES and then by presence (or absence) of MHD (depression, anxiety, substance abuse), 2) by MHD and then by SES, and 3) patients of low SES without MHD compared to patients of high SES with a MHD (data not shown in Table 1). High and low SES were defined as above or below the state of Michigan median household income ($46,859), estimated by patients’ home zip code. Demographics and outcomes were compared within and between groups.

Results: Among 3051 patients divided first by SES, there were a number of significant differences in demographics and outcomes between patients with and without MHD. Regardless of SES, patients with MHD were more often younger, female, single, and had higher rates of ED visits and readmissions at 180 days post-discharge than patients without MHD. Among high SES patients, patients with MHD had higher rates of ED visits within 30 days despite lower Charlson Comorbidity scores. In contrast, when divided by presence or absence of MHD first, fewer differences existed between SES groups. Regardless of presence or absence of MHDs, patients of low SES were younger and more racially diverse than patients of high SES; however, there were no differences in outcomes between these SES groups. Among patients without a MHD, low SES patients were less likely to attend BRIDGE. Patients of low SES without MHD were more likely than patients of high SES with MHD to be male (61.4% v. 51.2%, p<0.001), married (60.8% v. 52.2%, p=0.013), and non-White (75.3% v. 89.5%, p<0.001), and were less likely to have an ED visit within 180 days (31.9% v. 43.9%, p<0.001).

Conclusions: The presence of MHDs appears to be more strongly associated with negative outcomes than low SES. Efforts to develop and improve interventional care strategies that target patients with MHDs should be made to reduce these health disparities.

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