Date of Award

January 2022

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Sarwat C. Chaudhry

Abstract

The availability of social support is associated with health outcomes after acute myocardial infarction (AMI), yet previous studies have largely considered social support as a single entity, rather than examining its discrete domains. Furthermore, few studies have investigated the impact of social support in older AMI patients, in whom it may be especially important. This thesis aimed to determine the associations between 5 discrete domains of social support – emotional support, informational support, tangible support, positive social interaction, and affectionate support – with six-month readmission and mortality in older patients hospitalized for AMI, adjusting for known predictors of post-AMI outcomes. 3006 participants 75 years and older were recruited from a network of 94 hospitals across the United States. A 5-item version of the Medical Outcomes Study Social Support Survey was used to measure perceived social support, and readmission and mortality were ascertained six months after initial hospitalization. In multivariable analyses, low informational support was associated with readmission (odds ratio [OR], 1.22; 95% CI, 1.01-1.47), and low emotional support with mortality (OR, 1.43; 95% CI, 1.04-1.97). In conclusion, individual domains of social support had distinct, independent associations with post-AMI outcomes, lending a more nuanced understanding of this important social determinant of health. This work can inform the development of interventions and policies to improve post-AMI outcomes in the growing population of older persons.

Comments

This thesis is restricted to Yale network users only. This thesis is permanently embargoed from public release.

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