Social determinants of health (SDOH) data compiled from the Pulmonary Hypertension Association Registry (PHAR) were used to create a model that correlated with composite outcomes in patients with pulmonary arterial hypertension (PAH). The model, called the PHAR Evaluation, was discussed in an article published in Pulmonary Circulation.

The model was able to yield a c-statistic of 0.608 (95% CI, 0.583-0.632), which was significant compared to a random-chance model (P <.001), to predict an event during the next 6-month interval for patients. 

“The derivation of a model utilizing SDOH and their interactions to predict an important patient outcome is novel and important,” the authors said. “The ability to predict PAH outcomes based on SDOH is essential to identifying and helping those at greater risk.”

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“Our data suggests that even without including key hemodynamic variables, our model can predict if patients with PAH may have an event or not in a 6-month time interval,” the authors concluded.

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The composite outcome used for the model included death, hospitalization, and clinical worsening. Of the 3785 patient encounters included from the registry, 109 (2.88%) involved death, 1165 (30.78%) involved hospitalization, and 31 (0.82%) involved clinical worsening.

From the model, a lower incidence of the composite outcome was present in patients who reported alcohol use (odds ratio [OR], 0.67; P <.001), patients who were White, compared to those who were Black (OR, 0.22; P =.02), and patients of younger age (OR, 1.01; P =.038). Trends towards reduced events were observed in patients who were married and those who had private health insurance, higher education, and a higher income. An increased risk of events trended in patients with higher numbers in their household and a higher body mass index, male patients, and those who used drugs.

In addition, associations were observed between 3 significant factors (alcohol use, race, and age) and 6-minute walk distance. Race and age also showed associations with reported functional class.

The PHAR is the largest active, longitudinal registry in the United States. It was created in 2015 and included 47 Pulmonary Hypertension Care Centers (PHCCs) and 1275 patients as of 2020, when the data were analyzed for the paper.


Grinnan D, Kang L, DeWilde C, et al; PHAR Investigators. Prediction of patient outcomes through social determinants of health: the Pulmonary Hypertension Association Registry (PHAR) evaluation. Pulm Circ. 2022;12(3):e12120. doi:10.1002/pul2.12120