Elsevier

American Heart Journal

Volume 256, February 2023, Pages 37-50
American Heart Journal

Clinical Investigations
Relationships between neighborhood disadvantage and cardiovascular findings at autopsy in subjects with sudden death

https://doi.org/10.1016/j.ahj.2022.10.086Get rights and content

Background

Neighborhood disadvantage is associated with a higher risk of sudden cardiac death. However, autopsy findings have never been investigated in this context. Here, we sought to explore associations between neighborhood disadvantage and cardiovascular findings at autopsy in cases of sudden death in the State of Maryland.

Methods

State of Maryland investigation reports from 2,278 subjects within the CVPath Sudden Death Registry were screened for street addresses and 9-digit zip codes. Area deprivation index (ADI), used as metric for neighborhood disadvantage, was available for 1,464 subjects; 650 of whom self-identified as Black and 814 as White. The primary study outcome measurements were causes of death and gross and histopathologic findings of the heart.

Results

Subjects from most disadvantaged neighborhoods (i.e., ADI ≥ 8; n = 607) died at younger age compared with subjects from less disadvantaged neighborhoods (i.e., ADI ≤ 7; n = 857; 46.07 ± 14.10 vs 47.78 ± 13.86 years; P = 0.02) and were more likely Black or women. They were less likely to die from cardiac causes of death (61.8% vs 67.7%; P = 0.02) and had less severe atherosclerotic plaque features, including plaque burden, calcification, intraplaque hemorrhage, and thin-cap fibroatheromas. In addition, subjects from most disadvantaged neighborhoods had lower frequencies of plaque rupture (18.8% vs 25.1%, P = 0.004). However, these associations were omitted after adjustment for traditional risk factors and race.

Conclusion

Neighborhood disadvantage did not associate with cause of death or coronary histopathology after adjustment for cardiovascular risk factors and race, implying that social determinants of health other than neighborhood disadvantage play a more prominent role in sudden cardiac death.

Section snippets

Background

Socio-economically disadvantaged adults are more likely to experience premature death in the United States1., 2., 3. and elsewhere.4,5 Besides individual-level socioeconomic status (SES), neighborhood disadvantage has been shown to impact morbidity and health outcomes,6., 7., 8., 9. especially with regard to cardiovascular diseases (CVD). Neighborhood disadvantage has been associated with a higher incidence of coronary artery disease (CAD)8, heart failure9, and sudden cardiac arrest.10

CVD is

Study population

The CVPath Institute Sudden Death Registry samples are received through an ongoing joint consultation service provided to the State of Maryland Office Chief Medical Examiner (OCME-MD). Between 1994 and 2015, CVPath Institute was referred by the OCME a total of 4,327 hearts from Black or White subjects ≥18 years who died of unexpected sudden death. At OCME-MD, a complete and comprehensive autopsy and toxicologic analysis was performed in all referred decedents up to 50 years old and in cases

Results

Information on study design and exclusion criteria is given in Figure 1. The final cohort comprised 1,464 subjects, 650 of whom self-identified as Black and 814 as White. The mean age of the cohort was 47.07±13.98 years, and 71.5% were male (Table I).

Discussion

This is, to the best of our knowledge, the first autopsy study investigating associations between neighborhood disadvantage, causes of sudden death, and cardiac and coronary pathology in a cohort of Black and White Americans who died suddenly. An overall higher risk of sudden death in most disadvantaged neighborhoods has been reported previously,10 and in line with previous studies,7,27 subjects from most disadvantaged areas died at significantly younger age.

The reasons contributing to these

Conclusion

Our findings suggest differences in cardiac causes of death among less disadvantaged and most disadvantaged neighborhoods in the State of Maryland. In less disadvantaged neighborhoods, subjects tended to die of (CAD-related) cardiac causes while in most disadvantaged neighborhoods they tended to die of non-cardiac causes. However, these differences were no longer apparent when adjusted for race, implying that the influence of neighborhood disadvantage on causes of death may be linked to other

Disclosures

R.V. and A.V.F. have received institutional research support from R01 HL141425 Leducq Foundation Grant; 480 Biomedical; 4C Medical; 4Tech; Abbott; Accumedical; Amgen; Biosensors; Boston Scientific; Cardiac Implants; Celonova; Claret Medical; Concept Medical; Cook; CSI; DuNing, Inc; Edwards LifeSciences; Emboline; Endotronix; Envision Scientific; Lutonix/Bard; Gateway; Lifetech; Limflo; MedAlliance; Medtronic; Mercator; Merill; Microport Medical; Microvention; Mitraalign; Mitra assist; NAMSA;

Funding

This study was sponsored by CVPath Institute, a non-profit organization dedicated to cardiovascular research. S.J.N., Y.B. and T.M.P-W are funded by the Division of Intramural Research at the National Heart, Lung, and Blood Institute at the National Institutes of Health. T.M.P-W is also funded by the Intramural Research Program of the National Institute on Minority Health and Health Disparities of the National Institutes of Health.

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