Social Determinants of Health and 30-Day Readmissions Among Adults Hospitalized for Heart Failure in the REGARDS Study

Background: It is not known which social determinants of health (SDOH) impact 30-day readmission after a heart failure (HF) hospitalization among older adults. We examined the association of 9 individual SDOH with 30-day readmission after an HF hospitalization. Methods and Results: Using the REGARDS study (Reasons for Geographic and Racial Differences in Stroke), we included Medicare beneficiaries who were discharged alive after an HF hospitalization between 2003 and 2014. We assessed 9 SDOH based on the Healthy People 2030 Framework: race, education, income, social isolation, social network, residential poverty, Health Professional Shortage Area, rural residence, and state public health infrastructure. The primary outcome was 30-day all-cause readmission. For each SDOH, we calculated incidence per 1000 person-years and multivariable-adjusted hazard ratios of readmission. Among 690 participants, the median age was 76 years at hospitalization (interquartile range, 71–82), 44.3% were women, 35.5% were Black, 23.5% had low educational attainment, 63.0% had low income, 21.0% had zip code–level poverty, 43.5% resided in Health Professional Shortage Areas, 39.3% lived in states with poor public health infrastructure, 13.1% were socially isolated, 13.3% had poor social networks, and 10.2% lived in rural areas. The 30-day readmission rate was 22.4%. In an unadjusted analysis, only Health Professional Shortage Area was significantly associated with 30-day readmission; in a fully adjusted analysis, none of the 9 SDOH were individually associated with 30-day readmission. Conclusions: In this modestly sized national cohort, although prevalent, none of the SDOH were associated with 30-day readmission after an HF hospitalization. Policies or interventions that only target individual SDOH to reduce readmissions after HF hospitalizations may not be sufficient to prevent readmission among older adults.

Maternal Pre-Pregnancy Body Mass Index and Prenatal Sugar Consumption Predict Gestational Weight Gain and/or Postpartum Mental Health in a Health Professional Shortage Area

This study investigated whether the amount of third trimester added sugar consumption interacted with pre-pregnancy BMI (PPBMI) to predict gestational weight gain (GWG) and postpartum mental health in Health Professional Shortage Area (HPSA) for primary care and mental health. Participants included pregnant women aged 18 to 36, with data collected in-person at 33-37 weeks gestation and 6 months postpartum using an anthropometric measurement, Dietary Screener Questionnaire (DSQ), Edinburg Postnatal Depression Scale (EPDS), Prenatal Anxiety Screening Scale (PASS), and the 14-item Perceived Stress Scale (PSS). No moderated mediation models were statistically significant. Results indicated that greater PPBMI predicted decreased GWG and increased 6-month postpartum depression symptoms. There was a significant, positive correlation between prenatal added sugar intake and 6-month postpartum depression, anxiety, and perceived stress symptoms. Support for associations between increasing PPBMI and increasing depression symptoms at 6 months postpartum in this sample of women in an HPSA for primary care and mental health highlights the importance of starting preventative care for women prior to pregnancy. Correlations between greater added sugar intake in the third trimester and increased depression, anxiety, and perceived stress symptoms at 6 months postpartum supports the need for more research directly investigating those relationships, which could inform perinatal prevention/intervention research.