Social determinants of health as predictors of latent symptom clusters in patients undergoing maintenance hemodialysis: A secondary analysis of the HOPE consortium randomized trial.
Jennifer L Steel, Mark B Lockwood, Jonathan G Yabes et al.
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In 30 seconds
This secondary analysis of baseline data from the HOPE Consortium randomized trial examined symptom clusters and social determinants of health among 643 people receiving maintenance hemodialysis who had chronic pain. Latent profile analysis identified five symptom clusters, ranging from low levels of all symptoms to high levels of all symptoms. Compared with the average-symptom cluster, higher everyday discrimination was associated with greater odds of membership in the moderate-anxiety and high-symptom clusters. Greater residential segregation was associated with greater odds of membership in the low-anxiety cluster, while greater income inequality was associated with the moderate-anxiety cluster.
Key findings
- Latent profile analysis identified five symptom clusters, including low, average, and high levels of symptoms and two clusters distinguished by anxiety.
- Higher everyday discrimination was associated with greater odds of membership in the moderate-anxiety and high-symptom clusters, compared with the average-symptom cluster.
- Greater residential segregation was associated with greater odds of membership in the low-anxiety cluster.
- Greater income inequality was associated with greater odds of membership in the moderate-anxiety cluster.
Why it matters
The findings link social context with differing symptom profiles in people receiving hemodialysis who experience chronic pain. They suggest that symptom burden and anxiety may not be understood solely through individual clinical factors, and that discrimination and area-level conditions may be relevant when considering approaches to improve quality of life.
What to keep in mind
This was a secondary analysis of baseline data, so the reported associations do not establish that social determinants caused the symptom profiles or that changing them would reduce symptoms.