An Electronic, Preclinic, Social Determinants Survey Shows Pediatric Atherosclerotic Risk Factor Referral Identifies At-Risk Families

Abstract

Objective: Atherosclerotic risk factors are prevalent in childhood. Risk factors are associated with social determinants of health (SDoH), but have never been demonstrated in a clinical pediatric cardiology cohort. This report details the first use of a remotely deployed, previsit, self-administered electronic survey for the ascertainment of SDoH in youth referred to pediatric cardiology. We hypothesized that patients referred for atherosclerotic risk factors would have higher risk of SDoH factors. Study design: SDoH were assessed using validated instruments from the PRAPARE toolkit and the Accountable Health Communities Health-Related Social Needs Screening Tool automatically deployed days before a scheduled visit in a HIPAA compliant email link to patients. Hypertension, Lipid, and Electrophysiology referral visits were compared to referent General cardiology referral visits using generalized estimating equations to account for repeat visits. Results: Response rates were similar in each clinic, ranging from 17 to 22%. Compared to General Cardiology (n = 3543 visits), Hypertension referral (n = 1143) was significantly associated with having any SDoH problem (9.3% vs 22%), specifically being concerned about (6.3% vs 15.3%) or actual food insecurity (4.4% vs 12%), and lacking transportation to medical care (0.8% vs 5.3%). Lipid referral (n = 2344) was also associated with being concerned about (6.3% vs 10.2%) or actually food insecure (4.4% vs 8.5%), lacking transport to medical care (0.8% vs 2.6%), and inability to pay for utilities (1.2% vs 3.1%). Conclusions: Families with youth referred for atherosclerotic risk factors were at higher risk of food insecurity, transportation obstacles to medical visits, and obtaining utilities.

Keywords

• cardiovascular risk factors
• pediatric cardiology
• hypertension
• cholesterol
• social determinants of health
• digital health