Elsevier

Progress in Cardiovascular Diseases

Volume 76, January–February 2023, Pages 84-90
Progress in Cardiovascular Diseases

The association of disparities in neighborhood median household income and mortality in patients admitted to the hospital with atrial fibrillation

https://doi.org/10.1016/j.pcad.2022.11.016Get rights and content

Abstract

Background

Lower neighborhood median household income (nMHI) is associated with increased adverse outcomes in patients with atrial fibrillation (AF). However, its effect on mortality is yet unknown.

Methods

Data from the regional United States (U.S.) electronic medical records database, Research Action for Health Network (REACHnet), was extracted for adult patients with AF at Tulane Medical Center over 10 years. Annual nMHI & neighborhood high school graduation (HSG) data was collected from the US Census bureau. Only African Americans (AA) and Caucasians (CC) who had socioeconomic data were included. Low nMHI and low HSG were defined as ≤$25,000 & <90% respectively. High nMHI and HSG were defined as >$50,000 & ≥90% respectively. Primary endpoints were all cause and cardiovascular (CV) mortality. Cox-proportional hazard ratios were used to evaluate the endpoints.

Results

We included 4616 patients diagnosed with AF. During a median follow up of 4.6 years, 434 patients died of which 32.7% patients had CV mortality. There was a stepwise decrease in incidence of both all-cause and CV mortality as nMHI increased. Patients with low nMHI had the greatest risk of all-cause mortality (HR 1.9, C.I. 1.2–3.2, P 0.004). The association between low nMHI and all-cause mortality persisted after adjusting for age, sex, race, HSG and stroke risk factors using CHA2DS2VASC, delta CHA2DS2VASC scores and oral anticoagulant use. CV mortality followed a similar trend as all-cause mortality, however, this association was not significant after adjusting for the above variables. Apart from low nMHI, CHA2DS2VASC delta CHA2DS2VASC were statistically significant independent predictors of both all-cause and CV mortality.

Conclusion

Low nMHI is an independent risk factor for all cause and CV mortality in AF. Higher burden of co-morbidities is the driving force behind this disparity. Future studies should evaluate the role of educational and therapeutic intervention in these populations to reduce mortality.

Section snippets

Study design

We conducted a retrospective population based epidemiological study of all patients admitted to Tulane Medical Center with the diagnosis of AF from January 2010 to March 2020. Data was extracted from the regional US electronic medical records database, Research Action for Health Network (REACHnet), for all patients >18 years of age with a diagnosis of AF.

REACHnet is a regional US electronic medical records database comprising 13 clinical data research networks funded by the National

Baseline characteristics

Of the 5899 patients diagnosed with AF, 4616 were included in the study (Fig. 1). Mean age of the population was 63.7 years old. Out of the 4616 patients, 1508 were female. AA patients had a significantly lower nMHI than white patients (p < 0.001). Patients with high nMHI had a significantly higher HSG than patients with low nMHI (p < 0.001). In terms of co-morbidities, 722 had obstructive sleep apnea, 1673 had diabetes mellitus, and 2977 had hypertension (HTN). Low nMHI patients had

Discussion

Our study found that in patients admitted to our hospital with AF, during long term follow up, low nMHI independently predicts both all-cause and CV mortality. Patients living in neighborhoods with low nMHI were the most vulnerable population and had a greater than two-fold increased risk of all-cause and CV mortality when compared to patients living in neighborhoods with high nMHI. AA patients also had a near two-fold increase in the risk of all-cause mortality and CV mortality when compared

Conclusions and future directions

As more studies are being done, the association of SDOH and outcomes related to AF is getting clearer. Recognizing vulnerable populations allows us to judiciously allocate resources towards preventative and educational initiatives where they are needed most. In patients with AF, low nMHI is a significant risk factor for not only adverse outcomes but also mortality. Moving forward, studies should focus on the cause of this apparent disparity. In our study, multimorbidity was the driving force

Declaration of Competing Interest

Dr. Marrouche reports consulting fees from Abbott, Biotronik, Wavelet Health, Cardiac Design, Medtronic, Preventice, Vytronus, Biosense Webster, Marrek Inc., and Boston Scientific; research funding from Abbott, Boston Scientific, GE Healthcare, Siemens, Biotronik, Vytronus, and Biosense Webster; ownership interest in Marrek Inc. and Cardiac Designs; contracted research with Biosense Webster, Medtronic, St. Jude Medical, and Boston Scientific; and reports consulting fees from Biotronik and

Acknowledgements

The research reported in this article was conducted in partnership with Research Action for Health Network (REACHnet), funded by the Patient Centered Outcomes Research Institute® (PCORI Award RI-CRN-2020-008). REACHnet is a partner network in PCORnet®, the National Patient Centered Clinical Research Network, which was developed with funding from PCORI®. The content of this article is solely the responsibility of the author(s) and does not necessarily represent the views of other organizations

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