Social determinants of health as predictors of latent symptom clusters in patients undergoing maintenance hemodialysis: A secondary analysis of the HOPE consortium randomized trial.

The aims of this study were to characterize symptom clusters and examine the influence of social determinants of health (SDOH) on symptom cluster membership among people receiving maintenance hemodialysis and experiencing chronic pain. This study utilized baseline data collected from the 643 patients enrolled in the HOPE Consortium Trial designed to test the efficacy of an intervention to reduce chronic pain. Latent profile analyses were performed to characterize symptom clusters. SDOH variables were collected using self-report and the Census Geocoder. Five distinct clusters of symptoms were identified including (1) moderate levels of anxiety, (2) average level of all symptoms, (3) low levels of all symptoms, (4) low levels of anxiety, and (5) high levels of all symptoms. When compared to the symptom cluster with average level of symptoms, higher everyday discrimination scores were associated with higher odds of membership in the clusters reflecting moderate levels of anxiety and high levels of all symptoms. Greater residential segregation was associated with higher odds of being in the low anxiety cluster; and greater income inequality was associated with higher odds of membership in the moderate level anxiety symptom cluster. Multi-level interventions targeting discrimination and those living in areas with the greatest income inequality are warranted to reduce symptom burden and improve quality of life in this patient population. TRIAL REGISTRATION: ClinicalTrials.gov #NCT04571619. PERSPECTIVE STATEMENT: Social determinants of health (SDOH) such as discrimination and income inequality were associated with higher anxiety while segregation resulted in lower levels of anxiety reflecting the complex relationship between SDOH and mental health. Multi-level interventions targeting discrimination and income inequality are warranted to reduce symptom burden in this patient population.