Living in impoverished neighborhoods with few resources was found to be a risk factor for heart failure that was independent of individual socioeconomic status and cardiovascular risk in a newly published study.
Neighborhood deprivation was a significant predictor of heart failure incidence along with individual income, education level and other recognized cardiovascular risk factors in the analysis, published online in Circulation: Cardiovascular Quality and Outcomes.
The findings add to the evidence that addressing the lack of community-level resources in impoverished neighborhoods may have a “wide-reaching, population-level effect on mitigation of adverse cardiovascular outcomes including heart failure,” wrote researcher Elvis Akwo, MD, PhD, Loren Lipworth, ScD, and colleagues from Vanderbilt University School of Medicine, Nashville, Tennessee.
“Public policy has a big role to play in improving the health of populations,” Akwo told MedPage Today, “If you encourage one person to exercise more that will impact that person. But if you provide resources to make it easier to exercise in areas with neighborhood deprivation, that could have a wide-reaching impact.”
Prior studies have shown a strong independent association between living in poverty and heart failure risk, but the study is among the first to assess risk at a community level in a solely low-income population.
The researchers did this by examining data from the Southern Community Cohort Study (SCCS), which recruited low-income participants from 12 states in the southeastern United States.
“Within this cohort, we testing the hypothesis that neighborhood characteristics (defined by a composite deprivation index) predict the risk of incident heart failure beyond individual socioeconomic status,” the researchers wrote.
The analysis included data on 27,078 whites and blacks recruited into the SCCS during 2002 to 2009 who had no history of heart failure and were on Medicare or Medicaid.
The neighborhood deprivation index was constructed using principal components analysis based on census tract level socioeconomic variables. Cox models with Huber–White cluster sandwich estimator of variance were used to investigate the association between neighborhood deprivation index and heart failure risk.
The mean age of those included in the analysis was 55.5 years, 69% were black, 63% were female and 70% earned less than $15,000 a year.
More than 50% of participants lived in the most deprived neighborhoods (third neighborhood deprivation index tertile).
Among the main findings:
- 16% of participants were diagnosed with heart failure during median 5.2 years of follow-up
- After stratifying the neighborhood deprivation index scores into quartiles, each succeeding quartile was associated with a 12% increase in risk of heart failure (HR 1.12; 95% CI 1.07–1.18), adjusted for demographic, lifestyle, and clinical factors
- Neighborhood deprivation index scores represented 4.8% of the variance in heart failure risk
Akwo said the study was not designed to determine which specific factors associated with neighborhood deprivation contribute to increased cardiovascular risk, but prior research has shown that food deserts and lack of easy access to healthcare and sidewalks are linked to poorer community health.
In an editorial published with the study, Wayne Rosamond, PhD, and Anna Johnson, PhD, of the University of North Carolina at Chapel Hill, wrote that including only low-income participants in the study was a major strength because it greatly limited the potential for bias associated with individual stressors linked to living in poverty.
“The focus on an underserved population increases the paper’s relevance to broad public health goals such as the American Heart Association’s impact goals to improve the cardiovascular health of all Americans by 20% by 2020,” they wrote.
The direct measurement of heart failure using event analysis data, rather than medical claims data, was also cited as a study strength.
Rosamond and Johnson concluded that the study “challenges us to consider what types of interventions can be developed at the neighborhood level to reduce the burden of heart failure.”
“As the authors note, such ‘upstream measures’ designed to address the physical, social, and emotional stressors of disadvantaged residential environments have the most potential to reverse the growing burden of heart failure in the U.S.,” they wrote.
Funding for the SCCS was provided by the National Cancer Institute and the American Recovery and Reinvestment Act.
The researchers declared no relevant relationships with industry related to this study.