Associations of Social Vulnerability Index With Pathologic Myocardial Findings at Autopsy.
Associations of Social Vulnerability Index With Pathologic Myocardial Findings at Autopsy.
复制标题
DOI：
10.3389/fcvm.2021.805278
复制
发表时间：
2021
影响因子：
3.6
通讯作者：
Feinstein MJ
中科院分区：
文献类型：
--
作者：
Sunderraj A;Rivera A;Gaddam M;Kim S;McCook J;O'Neal J;Lomasney J;Lloyd-Jones DM;Baumer Y;Powell-Wiley TM;Feinstein MJ
背景：社会脆弱性是心血管健康的重要决定因素。先前的研究表明，健康的社会决定因素与心血管危险因素、影像学检查结果和临床事件有很强的相关性。然而，有限的数据存在的潜在作用，社会脆弱性和相关的生理压力对组织水平的病理。研究方法：我们分析了2002年4月6日至2021年4月1日在一家大型城市医疗中心进行尸检的853名死者的临床数据和尸检报告。平均死亡年龄为62.9岁（SD = 15.6），49%的死者为男性。主要暴露是基于疾病控制和预防中心社会脆弱性指数（SVI）的人口普查区综合社会脆弱性指数。每个人都按人口普查区进行地理编码，并相应地分配SVI。尸检的4个心肌组织水平结果记录为存在或不存在：任何冠状动脉粥样硬化、重度/阻塞性冠状动脉粥样硬化、心肌纤维化和/或心肌心包炎症。以SVI作为主要暴露量，协变量包括年龄、性别、种族、体重指数（BMI）、糖尿病和高血压，构建多变量调整的logistic回归模型。根据心力衰竭（HF）和冠状动脉疾病（CAD）的临床诊断进行分层的其他分析。结果：在整个队列中，SVI与多变量校正模型中的心脏病理结局无关。然而，在分层多变量校正分析中，在没有临床诊断为HF的个体中，较高的SVI（较高的社会脆弱性）与较高的心肌纤维化几率相关。结论：较高的社会脆弱性指数与无已知HF临床诊断的个体尸检时心肌纤维化的几率较高相关。潜在的病理生理机制和预防/治疗心肌功能不全的意义需要进一步研究。
Background: Social vulnerability is an important determinant of cardiovascular health. Prior investigations have shown strong associations of social determinants of health with cardiovascular risk factors, imaging findings, and clinical events. However, limited data exist regarding the potential role of social vulnerability and related physiologic stressors on tissue-level pathology. Methods: We analyzed clinical data and linked autopsy reports from 853 decedent individuals who underwent autopsy from 4/6/2002 to 4/1/2021 at a large urban medical center. The mean age at death was 62.9 (SD = 15.6) and 49% of decedent individuals were men. The primary exposure was census-tract level composite social vulnerability index based on the Centers for Disease Control and Prevention Social Vulnerability Index (SVI). Individuals were geocoded to census tracts and assigned SVI accordingly. Four myocardial tissue-level outcomes from autopsy were recorded as present or absent: any coronary atherosclerosis, severe/obstructive coronary atherosclerosis, myocardial fibrosis, and/or myopericardial inflammation. Multivariable-adjusted logistic regression models were constructed with SVI as the primary exposure and covariates including age, sex, race, body mass index (BMI), diabetes, and hypertension. Additional analyses were performed stratified by clinical diagnoses of heart failure (HF) and coronary artery disease (CAD). Results: In the overall cohort, SVI was not associated with outcomes on cardiac pathology in multivariable-adjusted models. However, in stratified multivariable-adjusted analyses, higher SVI (higher social vulnerability) was associated with a higher odds of myocardial fibrosis among individuals without clinical diagnoses of HF. Conclusions: Higher indices of social vulnerability are associated with a higher odds of myocardial fibrosis at autopsy among individuals without known clinical diagnoses of HF. Potential pathophysiological mechanisms and implications for prevention/treatment of myocardial dysfunction require further study.