Background: Disparities in implantable cardioverter-defibrillator (ICD) implant rates and survival to hospital discharge exist, negatively impacting Black individuals, women, or people with lower socioeconomic status. This study examined if social determinants of health (SDOH) were associated with ICD shocks, all-cause hospitalization, death, or patient-reported outcomes during the first year following an initial ICD.
Methods: This secondary analysis used data from a comparative effectiveness randomized controlled trial of a post-ICD patient intervention. Participants were followed for 1 year, and outcomes included ICD shocks, hospitalizations, death, physical function, psychological adjustment, and self-efficacy. SDOH indicators included age, biological sex, race and ethnicity, education level, employment status, household income, and rural/urban residence. Descriptive statistics, Pearson's χ2, and multivariate logistic regression were used to examine differences in outcomes by SDOH across the first year after ICD implant.
Results: Participants (N=301) were aged 64±12 years; 1% Asian/Pacific Islander, 4% Black, 2% Latinx, 2% Native American/Alaskan, and 91% White; 74% men; 87% urban residents; 65% retired/disabled/unemployed; 45% household income <$50 000/year; and 48% high school/vocational education or less. No significant associations were observed between SDOH and ICD shocks, hospitalization, or death. Physical health improved less for individuals with household income <$50 000 (P<0.001), while White participants (P=0.03) and rural residents (P=0.01) showed a greater reduction in ICD concerns.
Conclusions: SDOH were not associated with the incidence of ICD shocks, hospitalization, or death in the first year after receipt of an initial ICD. There were limited differences in the change in patient-reported outcomes over time by SDOH.
Keywords: defibrillators; patient‐reported outcome measures; social determinants of health.