Elsevier

The American Journal of Cardiology

Volume 140, 1 February 2021, Pages 83-90
The American Journal of Cardiology

Relation of Neighborhood Disadvantage to Heart Failure Symptoms and Hospitalizations

https://doi.org/10.1016/j.amjcard.2020.10.057Get rights and content

Residence in socioeconomically deprived neighborhoods may influence patient's health-related behaviors and overall health. We evaluated the association of neighborhood disadvantage on heart failure (HF) symptom burden and hospitalization rates. We characterized neighborhood deprivation in 359 HF subjects (age 56 ± 13 years, 52% black) in metropolitan Atlanta using the Area Deprivation Index (ADI). ANOVA was used to compare HF symptoms measured using the Kansas City Cardiomyopathy Questionnaire, and HF Self-Care Index across ADI tertiles. Zero-inflated Poisson regression was used to compare rates of recurrent HF hospitalization (HFH) across ADI tertiles. Subjects living in more deprived neighborhoods were more likely to be black, have Medicare or Medicaid insurance, and have a lower ejection fraction than those living in less deprived neighborhoods (all p ≤ 0.005). Subjects in more deprived neighborhoods had more severe HF symptoms (p < 0.001), but there was no difference in HF Self-Care Index scores across ADI tertiles. Subjects living in more deprived neighborhoods had a higher odds of being hospitalized for HF than subjects in less deprived neighborhoods. Once subjects had experienced a HFH, however, the association between ADI and the risk of recurrent HFH varied by racial group. In whites, increasing ADI was associated with a marginally decreased risk of recurrent HFH, while there was no association between ADI and recurrent HFH in blacks. In conclusion, patients with HF living in more deprived neighborhoods have greater symptom burden and are more likely to experience a HFH than those living in less deprived neighborhoods.

Section snippets

Methods

We pooled patient-level data from the Atlanta Cardiomyopathy Consortium (TACC) and the Metabolomics, Oxidative Stress and Vascular Function study, 2 prospective cohort studies which recruited outpatients with prevalent HF. TACC enrolled 336 patients from the HF clinics at 3 Emory University-affiliated hospitals from 2007 to 2011, according to the inclusion and exclusion criteria previously described.10 The Metabolomics, Oxidative Stress, and Vascular Function study is a follow-up study to TACC

Results

The baseline characteristics of the study cohort are shown in Table 1. Compared with participants in the least deprived tertile, participants living in the most deprived ADI group were more likely to be black (Figure 1). Additionally, participants living in the most deprived ADI group were more likely to have Medicare or Medicaid insurance, were less likely to have completed a college or graduate education, had a higher BMI, and a lower EF. Differences in baseline characteristics of the cohort

Discussion

In this prospective cohort analysis, we prospectively examined the association of neighborhood deprivation on hospitalization risk in HF patients living in the state of Georgia. Our main findings were that: (1) participants living in more socioeconomically deprived neighborhoods reported a greater HF symptom burden, but did not report differences in HF self-care; (2) participants living in more socioeconomically deprived neighborhoods had a higher risk of having at least 1 HF hospitalization

Disclosures

None of the authors have any conflicts of interest to report related to this research.

Declaration of Interests

The authors declare that they have no known competing financial interests or personal relations that could have appeared to influence the work reported in this study.

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      Similarly, SDOH often limit access to the growing armamentarium of medical and device therapies available to decrease morbidity and mortality for patients in whom HF is already manifest. Patients living in neighborhoods with a lower SES have more severe HF symptoms and an increased risk of adverse clinical outcomes, including incident HF and hospital readmissions.11,53–55 The association between neighborhood deprivation and HF risk may be mediated through environmental resources (eg, medical care, grocery stores), psychosocial stressors (lack of safety and social cohesion), and built environment attributes (eg, availability of transportation, greenspace, housing stability) that collectively impact lifestyle behaviors.

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    Dr. Morris has received research grants from NHLBI (NIH K23 HL124287 and R03 HL146874) and the Robert Wood Johnson Foundation (Harold Amos Medical Faculty Development Program). This work was also supported by the National Center for Advancing Translational Sciences of the NIH under Award number UL1TR002378. The content is solely the responsibility of the authors, and does not necessarily represent the official views of the NIH.

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