Disadvantaged Patients With CVD Face Barriers to COVID Prevention

Marlene Busko

May 15, 2021

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

Patients with cardiovascular disease (CVD) who had worse composite scores for six social determinants of health — economic stability, neighborhood quality, education, 30-day food security, community integration, and health insurance — were less likely to adhere to all the measures recommended to lower their risk of contracting and spreading COVID-19, according to a new study.

Compared to persons who are least disadvantaged, fewer of the most disadvantaged individuals followed all the recommended COVID-19 risk mitigation measures for personal protection (76% vs 89%) or social distancing (42% vs 59%), or could work from home/postpone work (26% vs 41%). 

These study findings, based on questionnaire replies from more than 2000 adults with self-reported CVD, including heart disease, myocardial infarction (MI), or stroke, were published online May 6 in Circulation: Cardiovascular Quality and Outcomes, and presented May 15 at the American College of Cardiology (ACC) 2021 Scientific Session.  

The results suggest that "if you were of a certain group where such health messaging from scientists and other experts was welcomed and was trusted," participants were more likely to practice the COVID-19 mitigation measures where possible, Kobina K. Hagan, MD, MPH, told theheart.org | Medscape Cardiology in an interview following a press briefing about the study.

Dr Kobina K. Hagan

Even if they trusted the heath messages, disadvantaged people had difficulties adhering to recommended risk mitigation practices because of financial reasons: if they struggled to have enough money to buy food, did not have paid sick days, or could not practice social distancing at their job or while traveling in public transport.

The current study findings "add to the growing evidence that socially disadvantaged populations face multiple barriers to healthy living, including limited capacity to engage in COVID-19 risk mitigation approaches," the researchers summarize.  

The survey was conducted in the United States between April and June 2020 when vaccines were not available, but the findings provide insight into current vaccine hesitancy in disadvantaged individuals, Hagan, a postdoctoral fellow from the Center for Outcomes Research, Houston Methodist Research Institute, Texas, pointed out.   

COVID-19 has amplified preexisting health inequities, and it shows that "health systems should be better set up to integrate the health-related social needs of patients with their clinical care," he urged.

"Our study supplements the call to identify and prioritize for vaccination and culturally competent health messaging, socially vulnerable populations whose limitation in adhering to the mitigation measures perpetuates the disparities in COVID-19," the group concludes.

Similar Disparities in a Disadvantaged Latinx Population

Invited to comment, Lilia Cervantes, MD, agreed that, as in a recent study that she led — based on interviews with 60 Latinx adults living in low-income areas of San Francisco, California, and Denver, Colorado, who survived a COVID-19 hospitalization — the current study shows how COVID-19 magnified preexisting health disparities.

In both studies, misunderstanding of health information coupled with economic anxiety were key findings, noted Cervantes, an associate professor in the Department of Medicine at Denver Health Medical Center in Colorado.

In the study of disadvantaged Latinx COVID-19 survivors, many individuals "expressed their desire to reduce the spread of COVID-19 in their communities through advocacy," she noted. "They described reaching out to their friends, neighbors, family members about their experience with COVID-19 as a means to warn people to use a mask and get vaccinated." 

According to Cervantes, this research showed that "community is important, especially in the Latinx community, and as clinicians, we can build trust and reduce misinformation by connecting with community and engaging community leaders."  

Similar to Hagan and colleagues, her group advises: "To confront COVID-19 as a compounder of social disadvantage, public health authorities should mitigate COVID-19–related misinformation, immigration fears, and challenges to health care access, as well as create policies that provide work protection and address economic disadvantages."

Higher Morbidity, Mortality

Individuals with CVD have a higher rate of morbidity and mortality from COVID-19, which makes it more important for them to take steps to lower their risk for infection, Hagan and colleagues note.

They hypothesized that socioeconomically disadvantaged adults with CVD may have a harder time following recommended COVID-19 risk mitigation practices.

They analyzed data from 25,269 U.S. adults in 10 states and 8 metropolitan areas who replied to the COVID-19 Household Impact Survey conducted by the National Opinion Research Center at the University of Chicago from April to June 2020.

Of these, 7% (2036 individuals) had self-reported CVD.

The researchers grouped participants with CVD into quartiles based on their disadvantaged quartile and 35% were the in the most disadvantaged quartile.  

Fewer of those in the least disadvantaged quartile than in the most disadvantaged quartile were age 60 years or older (51% vs 73%), but more were female (59% vs 30%), Black (18% vs 3.5%), or Hispanic (21% vs 6.6%).

More people in the most disadvantaged quartile than in the least disadvantaged quartile lacked a high school diploma (24% vs 0%), had a household income below $50,000 in 2019 (93% vs 3.7%), had sometimes or often run out of food during the previous 30 days (56% vs 0%), or had three or more comorbidities (64% vs 39%).

Compared to individuals with the least social adversity, those with the greatest social adversity were 17% less likely to follow all the personal protective measures: wearing a face mask, washing/sanitizing hands, and keeping a 6-foot distance from those outside their household (prevalence ratio [PR], 0.83; P = .009), after accounting for differences in demographic characteristics and comorbidities.

In addition, compared to individuals with the most favorable social risk profile, those with the least favorable profile were 31% less likely to adhere to all the recommended social distancing measures: cancelling or postponing group activities, avoiding crowded public places and restaurants, and avoiding contact with high-risk people (PR, 0.69; P = .018). They were also 47% less likely to work from home or cancel/postpone work (PR, 0.53; P = .002).

The study did not receive any funding. Hagan has no relevant financial disclosures. The disclosures of the other authors are listed with the article. Cervantes has no relevant financial disclosures.

American College of Cardiology (ACC) 2021 Annual Scientific Session. Presented May 15, 2021.

Circ Cardiovasc Qual Outcomes. Published online May 6, 2021. Abstract

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