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Neighborhood Socioeconomic Status and Mortality Among Heart Failure Patients
Citation:
Weaver, A., E. Pfaff, L. Neas, R. Devlin, W. Cascio, D. Diazsanchez, AND C. WardCaviness. Neighborhood Socioeconomic Status and Mortality Among Heart Failure Patients. International Society for Environmental Epidemiology, Utrecht, Provincial-State, NETHERLANDS, August 25 - 28, 2019.
Impact/Purpose:
Heart failure is a major public health concern in the USA and has a high mortality rate. Although neighborhood socioeconomic status is associated with other heart-related outcomes, it is unknown whether it is associated with mortality among heart failure patients. We examined hospital records from 30,060 heart failure patients who were seen at a University of North Carolina-affiliated hospital. We also used Census data to classify the state of North Carolina into seven distinct neighborhood socioeconomic clusters and assigned patients to one of these clusters. We observed that heart failure patients who live in relatively wealthy suburban areas have the lowest mortality, and those who live in rural areas and urban middle-class areas have the highest mortality. This project is among the largest to examine the effects of neighborhood factors on mortality among heart failure patients. This paper is relevant to environmental justice as it identifies high-risk populations that are particularly vulnerable to mortality. Future studies will incorporate air pollution measures to further identify neighborhood-level susceptibility to air pollution. This research will be presented at a professional environmental epidemiology conference.
Description:
Background Heart failure (HF) is a major public health concern in the USA with high mortality. Although neighborhood-level socioeconomic status (NSES) is associated with adverse health outcomes in the general community, it is unclear if NSES is associated with mortality in HF patients. Methods We used electronic health records from 30,060 heart failure patients seen at a University of North Carolina-affiliated hospital between July 1, 2004 and December 31, 2016. We created indicators for NSES using Ward’s hierarchical clustering of ten Census-based measures assessed at the block group level, yielding seven neighborhood clusters across North Carolina (NC). We conducted Cox proportional hazards analysis, adjusting for age, sex, and race, to evaluate differential hazards of mortality across the seven clusters. Results We assigned participants to one of seven clusters based on NSES and urbanicity: urban low-NSES (97% urban, n=3162), urban middle-low-NSES (91% urban, n=5078), urban middle-high-NSES (98% urban, n=2127), urban high-NSES (96% urban, n=5510), rural low-NSES (8% urban, n=2705), rural middle-NSES (13% urban, n=8258), and suburban high-NSES (85% urban, n=3220, referent). Compared to the referent suburban high-NSES cluster, hazards of mortality for HF patients were elevated in the urban middle-high-NSES (HR 1.14, 95% Confidence Interval [CI] 1.03-1.22), rural middle-NSES (HR 1.13, 95% CI 1.05-1.19), and rural low-NSES (HR 1.11, 95% CI 1.01-1.20) clusters. Hazard ratios were less elevated among urban middle-low-NSES (HR 1.08, 95% CI 0.99-1.15), urban low-NSES (HR 1.06, 95% CI 0.96, 1.14), and urban high-NSES (HR 1.06, 95% CI 0.97-1.13) clusters. Conclusions Among HF patients, hazards of mortality were generally more elevated for residents of traditionally understudied rural neighborhood clusters, compared to more urban clusters. Residents of the urban middle-high-NSES cluster had a more elevated hazard than other urban clusters, suggesting that additional factors in this cluster may contribute to mortality. This abstract does not necessarily reflect EPA policies.