{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T06:17:48Z","timestamp":1788329868943,"version":"build-2803163510"},"reference-count":35,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"17","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2026,9,1]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Social determinants of health (SDOH) are increasingly recognized as contributors to disparities in cardiovascular outcomes. However, their incremental value in risk prediction models for ST\u2010segment\u2013elevation myocardial infarction (STEMI) death remains uncertain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">We analyzed hospital admissions for STEMI between 2018 and 2020 using the American Heart Association's GWTG\u2010CAD (Get With The Guidelines\u2013Coronary Artery Disease) registry. Logistic regression models were constructed: a clinical model including demographic, clinical, and medical history variables, and a full SDOH model that additionally incorporated zip code\u2013level SDOH (college graduation, high school graduation, per\u2010capita income, poverty, foreign\u2010born status, and median household income). Discrimination was assessed using the concordance statistic\/area under the receiver operating characteristic curve, and incremental value was evaluated with DeLong's test. Missing data were addressed with multiple imputation by chained equations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">The imputed cohort included 749\u2009410 STEMI admissions (median age, 62\u2009years, 72% men). Both the clinical and SDOH models demonstrated excellent discrimination (concordance statistic, 0.95; area under the receiver operating characteristic curve, 0.85), with no meaningful difference in overall predictive performance. In exploratory analyses, the addition of high school graduation, college graduation, per\u2010capita income, poverty, and foreign\u2010born status each had a modest statistical improvement in model discrimination, whereas median household income did not.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">Incorporating SDOH variables into an already high\u2010performing clinical risk model for in\u2010hospital STEMI death did not meaningfully enhance prediction. These findings indicate that short\u2010term, in\u2010hospital survival is primarily driven by immediate clinical factors rather than upstream socioenvironmental risks.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.125.047813","type":"journal-article","created":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T11:44:10Z","timestamp":1787226250000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Role of Social Determinants of Health in Risk Prediction Models for ST\u2010Segment\u2013Elevation Myocardial Infarction Death: A Registry\u2010Based Study"],"prefix":"10.1161","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3345-2655","authenticated-orcid":false,"given":"Elina E.","family":"Pliakos","sequence":"first","affiliation":[{"name":"University of Pennsylvania Perelman School of Medicine","place":["Philadelphia, USA"]},{"name":"University of Pennsylvania","place":["Philadelphia, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaitlyn","family":"Shultz","sequence":"additional","affiliation":[{"name":"University of Pennsylvania","place":["Philadelphia, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kriyana P.","family":"Reddy","sequence":"additional","affiliation":[{"name":"University of Pennsylvania","place":["Philadelphia, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0879-7694","authenticated-orcid":false,"given":"Lauren A.","family":"Eberly","sequence":"additional","affiliation":[{"name":"University of Pennsylvania Perelman School of Medicine","place":["Philadelphia, USA"]},{"name":"University of Pennsylvania","place":["Philadelphia, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1345-3004","authenticated-orcid":false,"given":"Sameed A. M.","family":"Khatana","sequence":"additional","affiliation":[{"name":"University of Pennsylvania Perelman School of Medicine","place":["Philadelphia, USA"]},{"name":"University of Pennsylvania","place":["Philadelphia, USA"]},{"name":"University of Pennsylvania","place":["Philadelphia, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9060-5307","authenticated-orcid":false,"given":"Alexander C.","family":"Fanaroff","sequence":"additional","affiliation":[{"name":"University of Pennsylvania Perelman School of Medicine","place":["Philadelphia, USA"]},{"name":"University of Pennsylvania","place":["Philadelphia, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7374-4292","authenticated-orcid":false,"given":"Peter W.","family":"Groeneveld","sequence":"additional","affiliation":[{"name":"University of Pennsylvania Perelman School of Medicine","place":["Philadelphia, USA"]},{"name":"University of Pennsylvania","place":["Philadelphia, USA"]},{"name":"University of Pennsylvania","place":["Philadelphia, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8076-0098","authenticated-orcid":false,"given":"Jay","family":"Giri","sequence":"additional","affiliation":[{"name":"University of Pennsylvania Perelman School of Medicine","place":["Philadelphia, USA"]},{"name":"University of Pennsylvania","place":["Philadelphia, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7227-6423","authenticated-orcid":false,"given":"Ashwin S.","family":"Nathan","sequence":"additional","affiliation":[{"name":"University of Pennsylvania Perelman School of Medicine","place":["Philadelphia, USA"]},{"name":"University of Pennsylvania","place":["Philadelphia, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2025.12919"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-149-10-200811180-00009"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2013-004425"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0166391"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cct.2012.01.001"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.118.004979"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2018.11.111"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2020.05.025"},{"key":"e_1_3_1_10_2","doi-asserted-by":"publisher","DOI":"10.1177\/2047487319852680"},{"key":"e_1_3_1_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2017.06.041"},{"key":"e_1_3_1_12_2","doi-asserted-by":"publisher","DOI":"10.1161\/HCQ.0000000000000133"},{"key":"e_1_3_1_13_2","unstructured":"AHA . Get With The Guidelines\u00ae\u2014Coronary Artery Disease. 2025. https:\/\/www.heart.org\/en\/professional\/quality\u2010improvement\/get\u2010with\u2010the\u2010guidelines\/get\u2010with\u2010the\u2010guidelines\u2010coronary\u2010artery\u2010disease."},{"key":"e_1_3_1_14_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001191"},{"key":"e_1_3_1_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjca.2020.11.010"},{"key":"e_1_3_1_16_2","doi-asserted-by":"publisher","DOI":"10.1093\/biomet\/63.3.581"},{"key":"e_1_3_1_17_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.106.672402"},{"key":"e_1_3_1_18_2","doi-asserted-by":"publisher","DOI":"10.2307\/2531595"},{"key":"e_1_3_1_19_2","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kws207"},{"key":"e_1_3_1_20_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2017.12126"},{"key":"e_1_3_1_21_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.8584"},{"key":"e_1_3_1_22_2","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0b013e318222a508"},{"key":"e_1_3_1_23_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.cir.0000437741.48606.98"},{"key":"e_1_3_1_24_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.120.006752"},{"key":"e_1_3_1_25_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0312756"},{"key":"e_1_3_1_26_2","unstructured":"MESA . Multi\u2010Ethnic Study of Atherosclerosis (MESA). 2025. Accessed October 5 2025. https:\/\/www.mesa\u2010nhlbi.org\/."},{"key":"e_1_3_1_27_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.122.009304"},{"key":"e_1_3_1_28_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2013.12.082"},{"key":"e_1_3_1_29_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2023.1699"},{"key":"e_1_3_1_30_2","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2025.1724572"},{"key":"e_1_3_1_31_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12872-017-0683-2"},{"key":"e_1_3_1_32_2","doi-asserted-by":"publisher","DOI":"10.2196\/50067"},{"key":"e_1_3_1_33_2","doi-asserted-by":"publisher","DOI":"10.1016\/0003-2697(85)90608-6"},{"key":"e_1_3_1_34_2","doi-asserted-by":"publisher","DOI":"10.1002\/sim.5328"},{"key":"e_1_3_1_35_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2025.5047"},{"key":"e_1_3_1_36_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.12109"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.125.047813","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T06:03:22Z","timestamp":1788329002000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.125.047813"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,1]]},"references-count":35,"journal-issue":{"issue":"17","published-print":{"date-parts":[[2026,9,1]]}},"alternative-id":["10.1161\/JAHA.125.047813"],"URL":"https:\/\/doi.org\/10.1161\/jaha.125.047813","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,1]]},"assertion":[{"value":"2025-11-13","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-07","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-20","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e047813"}}