Abstract
Background: Neighborhood-level characteristics, such as poverty, have been associated with risk factors for heart failure (HF), including hypertension and diabetes mellitus. However, the independent association between neighborhood poverty and incident HF remains understudied. Objective: To evaluate the association between neighborhood poverty and incident HF using a “real-world” clinical cohort. Design: Retrospective cohort study of electronic health records from a large healthcare network. Individuals’ residential addresses were geocoded at the census-tract level and categorized by poverty tertiles based on American Community Survey data (2007–2011). Participants: Patients from Northwestern Medicine who were 30–80 years, free of cardiovascular disease at index visit (January 1, 2005–December 1, 2013), and followed for at least 5 years. Main Measures: The association of neighborhood-level poverty tertile (low, intermediate, and high) and incident HF was analyzed using generalized linear mixed effect models adjusting for demographics (age, sex, race/ethnicity) and HF risk factors (body mass index, diabetes mellitus, hypertension, smoking status). Key Results: Of 28,858 patients included, 75% were non-Hispanic (NH) White, 43% were men, 15% lived in a high-poverty neighborhood, and 522 (1.8%) were diagnosed with incident HF. High-poverty neighborhoods were associated with a 1.80 (1.35, 2.39) times higher risk of incident HF compared with low-poverty neighborhoods after adjustment for demographics and HF risk factors. Conclusions: In a large healthcare network, incident HF was associated with neighborhood poverty independent of demographic and clinical risk factors. Neighborhood-level interventions may be needed to complement individual-level strategies to prevent and curb the growing burden of HF.
Original language | English (US) |
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Pages (from-to) | 3719-3727 |
Number of pages | 9 |
Journal | Journal of general internal medicine |
Volume | 36 |
Issue number | 12 |
DOIs | |
State | Published - Dec 2021 |
Funding
This work was supported in part by the Northwestern Medicine Enterprise Data Warehouse. The funding sponsor did not contribute to design and conduct of the study, collection, management, analysis, or interpretation of the data or preparation, review, or approval of the manuscript. The authors take responsibility for decision to submit the manuscript for publication. Dr. Khan had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Research reported in this publication was supported, in part, by the National Institutes of Health’s National Center for Advancing Translational Sciences, Grant Number KL2TR001424 (SSK), and the American Heart Association (#19TPA34890060) to SSK. Dr. Rethy was supported by a research fellowship from the Sarnoff Cardiovascular Research Foundation (2018–-2019). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. There are no relationships with industry to disclose.
Keywords
- heart failure
- incidence
- neighborhood poverty
- racial/ethnic disparities
ASJC Scopus subject areas
- Internal Medicine