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    Patient and Social Determinants of Health Trajectories Following Coronary Events

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    Authors
    Nobel, Lisa
    Faculty Advisor
    Jeroan J. Allison
    UMass Chan Affiliations
    Quantitative Health Sciences
    Document Type
    Doctoral Dissertation
    Publication Date
    2017-03-24
    Keywords
    acute coronary syndrome
    ACS
    quality of life
    patient health status
    PHS
    predictions
    socioeconomic status
    SES
    TRACE-CORE
    Cardiology
    Cardiovascular Diseases
    Clinical Epidemiology
    Epidemiology
    Health Services Research
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    Abstract
    More than 1.2 million Americans are hospitalized annually with an acute coronary syndrome (ACS); many impaired quality of life after discharge with an ACS. This dissertation focuses on two novel aspects of patient health status (PHS) after ACS: how it can be predicted based on the socioeconomic status (SES) of the patient, and how it evolves over time. We used data from TRACE-CORE, a longitudinal prospective cohort of patients hospitalized with ACS. We measured PHS using both the SF-36 mental and physical component subscales (MCS and PCS) and the Seattle Angina Questionnaire (SAQ) health-related quality of life (HRQoL) and physical limitations subscales at the index hospitalization and at 1, 3, and 6-months post-discharge. Firstly, after adjusting for individual-level SES, we found that individuals living in the neighborhoods with the lowest neighborhood SES had significantly worse PHS. Secondly, we found that each of the components of PHS had subgroups with distinct patterns of evolution over time (trajectories). Both the PCS and the SAQ physical limitations subscale had two trajectories; one with average and one with impaired health status over time. For the HRQoL subscale of SAQ, we found three trajectories: Low, Average, and High scores. For MCS, we found four trajectories: High (consistently high scores), Low (consistently low scores), and two with average scores at baseline that either improved or worsened over time, referred to as Improving and Worsening, respectively. All PHS trajectories, except for MCS, predicted readmission and mortality during the 6 months to 1 year post-ACS discharge.
    DOI
    10.13028/M2MQ1B
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/32291
    Rights
    Copyright is held by the author, with all rights reserved.
    ae974a485f413a2113503eed53cd6c53
    10.13028/M2MQ1B
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    Morningside Graduate School of Biomedical Sciences Dissertations and Theses

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