Abstract 15466: Social Determinants of Health Vulnerabilities Among Patients With Substance Use Disorder and Infective Endocarditis

Introduction: Data indicate that the incidence of infective endocarditis (IE) is rising among patients with substance use disorder (SUD) and is linked with increased mortality. However, the social determinants of health (SDOH) vulnerabilities associated with IE in this population has not been well characterized.

Aims: To examine the SDOH associated with IE among patients with SUD.

Methods: Using our electronic medical records, we identified patients with concurrent diagnosis of IE and SUD from 2017 until May 2023. Socio-demographics and SDOH including unstable housing (identified using diagnosis codes, residential address test, and natural language processing of clinical notes documenting homelessness and shelter referrals) were identified. A multivariable regression model was conducted to identity independent risk factors associated with IE among patients with SUD.

Results: Among 26,918 patients admitted with an SUD encounter, 1,422 (5.3%) had an IE encounter. Patients with IE were younger (37 vs 43 years, P<0.001), mostly white (96% vs 87.7%, P<0.001), Medicaid enrollees (84.2% vs 58.6%, P<0.001), and had less than high school education (10.6% vs 8.1%, P=0.005). They were more likely to reside in rural areas (58.1% vs 44.8%) and have unstable housing (28.6% vs 16.3%). Patients with IE had higher prevalence of smoking (83.5% vs 67.3%) as well as cardiac, dental, mental and other health conditions. Certain socio-demographics and SDOH were independently associated with IE on multivariable regression (Figure).

Conclusions: Patients with SUD and IE have distinct socio-demographics and SDOH characteristics. Incorporating these factors into future risk prediction tools could better help identifying SUD patients who are at risk to implement targeted techniques which have been proven to lower the risk of infection.