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dc.contributor.advisorJeroan J. Allison
dc.contributor.authorNobel, Lisa
dc.date2022-08-11T08:08:46.000
dc.date.accessioned2022-08-23T16:07:39Z
dc.date.available2022-08-23T16:07:39Z
dc.date.issued2017-03-24
dc.date.submitted2017-08-02
dc.identifier.doi10.13028/M2MQ1B
dc.identifier.urihttp://hdl.handle.net/20.500.14038/32291
dc.description.abstractMore 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.
dc.language.isoen_US
dc.rightsCopyright is held by the author, with all rights reserved.
dc.subjectacute coronary syndrome
dc.subjectACS
dc.subjectquality of life
dc.subjectpatient health status
dc.subjectPHS
dc.subjectpredictions
dc.subjectsocioeconomic status
dc.subjectSES
dc.subjectTRACE-CORE
dc.subjectCardiology
dc.subjectCardiovascular Diseases
dc.subjectClinical Epidemiology
dc.subjectEpidemiology
dc.subjectHealth Services Research
dc.titlePatient and Social Determinants of Health Trajectories Following Coronary Events
dc.typeDoctoral Dissertation
dc.identifier.legacyfulltexthttps://escholarship.umassmed.edu/cgi/viewcontent.cgi?article=1914&context=gsbs_diss&unstamped=1
dc.identifier.legacycoverpagehttps://escholarship.umassmed.edu/gsbs_diss/910
dc.legacy.embargo2019-08-01T00:00:00-07:00
dc.identifier.contextkey10530284
refterms.dateFOA2022-08-29T15:44:08Z
html.description.abstract<p>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.</p>
dc.identifier.submissionpathgsbs_diss/910
dc.contributor.departmentQuantitative Health Sciences
dc.identifier.orcid0000-0002-9625-3592


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