Patient and Social Determinants of Health Trajectories Following Coronary Events
Authors
Nobel, LisaFaculty Advisor
Jeroan J. AllisonUMass Chan Affiliations
Quantitative Health SciencesDocument Type
Doctoral DissertationPublication Date
2017-03-24Keywords
acute coronary syndromeACS
quality of life
patient health status
PHS
predictions
socioeconomic status
SES
TRACE-CORE
Cardiology
Cardiovascular Diseases
Clinical Epidemiology
Epidemiology
Health Services Research
Metadata
Show full item recordAbstract
More than 1.2 million Americans are hospitalized annually with an acute coronary syndrome (ACS); many impaired quality of life after discharge with an ACS. This dissertation focuses on two novel aspects of patient health status (PHS) after ACS: how it can be predicted based on the socioeconomic status (SES) of the patient, and how it evolves over time. We used data from TRACE-CORE, a longitudinal prospective cohort of patients hospitalized with ACS. We measured PHS using both the SF-36 mental and physical component subscales (MCS and PCS) and the Seattle Angina Questionnaire (SAQ) health-related quality of life (HRQoL) and physical limitations subscales at the index hospitalization and at 1, 3, and 6-months post-discharge. Firstly, after adjusting for individual-level SES, we found that individuals living in the neighborhoods with the lowest neighborhood SES had significantly worse PHS. Secondly, we found that each of the components of PHS had subgroups with distinct patterns of evolution over time (trajectories). Both the PCS and the SAQ physical limitations subscale had two trajectories; one with average and one with impaired health status over time. For the HRQoL subscale of SAQ, we found three trajectories: Low, Average, and High scores. For MCS, we found four trajectories: High (consistently high scores), Low (consistently low scores), and two with average scores at baseline that either improved or worsened over time, referred to as Improving and Worsening, respectively. All PHS trajectories, except for MCS, predicted readmission and mortality during the 6 months to 1 year post-ACS discharge.DOI
10.13028/M2MQ1BPermanent Link to this Item
http://hdl.handle.net/20.500.14038/32291Rights
Copyright is held by the author, with all rights reserved.ae974a485f413a2113503eed53cd6c53
10.13028/M2MQ1B