Observational studyCirculation. Cardiovascular quality and outcomes2020
Social Determinants of Health Improve Predictive Accuracy of Clinical Risk Models for Cardiovascular Hospitalization, Annual Cost, and Death.
Observational study in Circulation. Cardiovascular quality and outcomes, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 44 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
44 citing papers in PubMed, 2 syntheses or guidelines pooled it, 58 citations in OpenAlex.
- Impact of social determinants of health on perioperative and interstage outcomes in congenital heart surgery a systematic review.Frontiers in cardiovascular medicine · 2026Pooled it
- The Role of Social Determinants of Health in Cardiovascular Diseases: An Umbrella Review.Journal of the American Heart Association · 2023Pooled it
- Financial Toxicity and Multidimensional Economic Strain Among Dementia Caregivers.Alzheimer's & dementia. Behavior & socioeconomics of aging · 2026Article
- Adaptation of a fair individualized polysocial risk score for hospitalization risk prediction.JAMIA open · 2026Article
- Chronic Conditions and Mortality in Medicare Beneficiaries Before and After the COVID-19 Pandemic.JAMA network open · 2026Article
- Strategies for mitigating artificial intelligence bias in healthcare: a systematic review.JAMIA open · 2026Review
- Postpartum readmission for hypertension: Validating a predictive model with incorporation of neighborhood-level social determinants of health.Pregnancy (Hoboken, N.J.) · 2026Article
- Social determinants of health diagnosis codes in in-person and telehealth visits during pregnancy in the United States, 2020-2025: a repeated cross-sectional and case-control study.BMC pregnancy and childbirth · 2026Article
- A Machine Learning Model to Improve Risk Adjustment Accuracy in Medicare.Health services research · 2026Article
- Social determinants of health and hospitalization risk in heart failure: A Retrospective analysis.American heart journal plus : cardiology research and practice · 2026Article
- Cardiovascular risk stratification without recalibration: A comparative study of the PREVENT and WHO risk scores in a multiethnic Brazilian cohort.American journal of preventive cardiology · 2026Article
- Patient-Centered Communication in Telehealth Settings.JAMA network open · 2026Article
- A social determinants-based county-level cardiovascular mortality index to identify high-risk counties in the USA.BMC medicine · 2025Article
- Barriers and Solutions to Efficient Health Care AI Implementation.JAMA network open · 2025Article
- Developing and Applying the BE-FAIR Equity Framework to a Population Health Predictive Model: A Retrospective Observational Cohort Study.Journal of general internal medicine · 2025Observational
- The association between social vulnerability index and survival in older adults with gastrointestinal cancers - The CARE Registry.Journal of geriatric oncology · 2025Article
- Impact of Social Determinants of Health on Cardiovascular Disease.Journal of the American Heart Association · 2025Review
- Associations of cardiovascular health and social determinants of health with the risks of all-cause and cause-specific mortality.PloS one · 2025Article
- A Global Perspective on Socioeconomic Determinants of Cardiovascular Health.The Canadian journal of cardiology · 2025Review
- Article
Corrections and comments
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Authors and funding
4 authors at 2 institutions in 1 country.
Funding
Abstract
backgroundRisk models in the private insurance setting may systematically underpredict in the socially disadvantaged. In this study, we sought to determine whether US minority Medicare beneficiaries had disproportionately low costs compared with their clinical outcomes and whether adding social determinants of health (SDOH) into risk prediction models improves prediction accuracy. METHODS AND
resultsRetrospective observational cohort study of 2016 to 2017 Medicare Current Beneficiary Survey data (n=3614) linked to Medicare fee-for-service claims. Logistic and linear regressions were used to determine the relationship between race/ethnicity and annual costs of care, all-cause hospitalization, cardiovascular hospitalization, and death. We calculated the observed-to-expected (O:E) ratios for all outcomes under 4 risk models: (1) age+sex, (2) model 1+clinical comorbidity adjustment, (3) model 2+SDOH, and (4) SDOH alone. Our sample was 44% male and 11% black or Hispanic. Among minorities, adverse clinical outcomes were inversely related to cost. After multivariable adjustment, blacks/Hispanics had higher rates of cardiovascular hospitalization (incidence rate ratio, 1.78;
conclusionsA paradoxical relationship was observed between clinical outcomes and costs among racial and ethnic minorities. Because of systematic differences in access to care, cost may not be an appropriate surrogate for predicting clinical risk among vulnerable populations. Adjustment for SDOH improves the accuracy of risk models among racial and ethnic minorities and could guide use of prevention strategies.
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