Impact Of Social Determinants Of Health On Mortality After Transcatheter Aortic Valve Replacement: A Single-Center Study

BackgroundSocial determinants of health (SDOH) affect access to transcatheter aortic valve replacement (TAVR), yet their impact on post-procedural mortality remains incompletely defined. We investigated the association between neighborhood-level social deprivation and post-TAVR mortality, readmission, cardiovascular events, and procedural outcomes. MethodsWe performed a retrospective cohort study of 727 consecutive TAVR patients (2023-2024) with 1-year follow-up data at a central New Jersey tertiary care academic medical center, stratified into quartiles based on the composite Social Deprivation Index (SDI) and its seven constituent domains (Q1 = least deprived; Q4 = most deprived). Kaplan-Meier survival analysis with log-rank testing and Cox proportional hazards regression adjusted for STS-PROM score were used to evaluate mortality across quartiles. ResultsThe cohort (mean age 80.4 years; 46% female; 87% White; mean STS-PROM 5.5%) was skewed toward lower-deprivation neighborhoods (85% in Q1-Q2). Survival differed significantly across SDI quartiles at 30 days (log-rank p=0.037) and 90 days (p=0.049), but not at 1 year (p=0.164). In Cox regression, composite SDI was not a significant predictor of one-year mortality. Domain-specific analysis identified single-parent household density as the only significant mortality predictor, with patients in Q4 having higher 1-year mortality than those in Q1 (aHR 2.65, 95% CI 1.15-6.14, p=0.023). Procedural events, overall 30-day readmissions, and 30-day composite cardiovascular events did not differ significantly across SDI quartiles (all p>0.05). ConclusionNeighborhood-level social deprivation was not independently associated with post-TAVR all-cause mortality, though underrepresentation of patients from highly deprived neighborhoods highlights ongoing access disparities. Single-parent household density, a marker of social fragmentation, demonstrated a hypothesis-generating association with increased mortality risk, suggesting a potential role for neighborhood social fragmentation in post-TAVR outcomes that warrants prospective validation. These findings support equitable TAVR access while highlighting social support as an area for future investigation.