Gendered social determinants of health and risk of major adverse outcomes in atrial fibrillation
Why this work is in the frame
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Bibliographic record
Abstract
INTRODUCTION: Atrial fibrillation (AF) is associated with an increased risk of adverse outcomes. Clinical risk factors have been identified as predictors of such outcomes, but social determinants of health (SDOH) may also play a role. We evaluated the associations between gendered SDOH (unevenly distributed between sexes) and adverse outcomes in AF. METHODS: This is a retrospective cohort study using data from a European registry of AF patients from 250 centers and twenty-seven countries. Gendered SDOH included education, living status, subscales of the EQ-5D-5L questionnaire, behavioral factors, and country-level gender inequality index (GII). The primary outcome was a composite of major adverse cardiovascular events and all-cause mortality. We used multivariate logistic regression models to identify associations between SDOH and the primary outcome. RESULTS: -VASc score. Most participants had secondary education, were physically inactive, lived in countries with gender equity and reported at least moderately elevated quality of life measures; they were less likely to live alone, smoke or drink alcohol. After adjustment for clinical factors, not having any post-secondary education (OR:1.17 95 %CI:1.05-1.28), reporting poorer health status (OR:1.08 95 %CI:1.05-1.11), living in a country with a higher GII (higher gender inequity) (OR:1.12 95 %CI:1.03-1.22 each 0.100), reporting reduced mobility (OR:1.18 95 %CI:1.02-1.38) and reduced self-care (OR:1.35;95 %CI:1.14-1.61) were independently associated with worse outcomes. CONCLUSIONS: Gendered SDOH are independently associated with adverse events in patients with AF. These factors should be considered for assessment of risk and as potential targets for interventions to improve outcomes. CONDENSED ABSTRACT: Atrial fibrillation (AF) is associated with adverse outcomes and social determinants of health (SDOH), which are gendered, may predict adverse outcomes in AF. We used a registry of AF patients from 27 European countries. Multivariate logistic regressions were used to investigate the associations between gendered SDOH and the primary outcome, a composite of major adverse cardiovascular events and all-cause mortality. Several SDOH were independent predictors: no higher education (OR:1.17;95 %CI:1.05-1.28), lower health (OR:1.08;95 %CI:1.05-1.11), higher GII (OR:1.12;95 %CI:1.03-1.22 each 0.100), reduced mobility (OR:1.18;95 %CI:1.02-1.38) and reduced self-care (OR:1.35;95 %CI:1.14-1.61). Gendered SDOH are independently associated with adverse events in AF.
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it