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Accepted (AM)Open Access (License Unspecified), Open
Journal article
Neighborhood Disadvantage and Risk of Heart Failure: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study
Circulation Cardiovascular quality and outcomes, e009867
08 Feb 2024
PMID: 38328917
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Heart failure (HF) affects >6 million US adults, with recent increases in HF hospitalizations. We aimed to investigate the association between neighborhood disadvantage and incident HF events and potential differences by diabetes status.
We included 23 645 participants from the REGARDS study (Reasons for Geographic and Racial Differences in Stroke), a prospective cohort of Black and White adults aged ≥45 years living in the continental United States (baseline 2005-2007). Neighborhood disadvantage was assessed using a
score of 6 census tract variables (2000 US Census) and categorized as quartiles. Incident HF hospitalizations or HF-related deaths through 2017 were adjudicated. Multivariable-adjusted Cox regression was used to examine the association between neighborhood disadvantage and incident HF. Heterogeneity by diabetes was assessed using an interaction term.
The mean age was 64.4 years, 39.5% were Black adults, 54.9% females, and 18.8% had diabetes. During a median follow-up of 10.7 years, there were 1125 incident HF events with an incidence rate of 3.3 (quartile 1), 4.7 (quartile 2), 5.2 (quartile 3), and 6.0 (quartile 4) per 1000 person-years. Compared to adults living in the most advantaged neighborhoods (quartile 1), those living in neighborhoods in quartiles 2, 3, and 4 (most disadvantaged) had 1.30 (95% CI, 1.06-1.60), 1.36 (95% CI, 1.11-1.66), and 1.45 (95% CI, 1.18-1.79) times greater hazard of incident HF even after accounting for known confounders. This association did not significantly differ by diabetes status (interaction
=0.59). For adults with diabetes, the adjusted incident HF hazards comparing those in quartile 4 versus quartile 1 was 1.34 (95% CI, 0.92-1.96), and it was 1.50 (95% CI, 1.16-1.94) for adults without diabetes.
In this large contemporaneous prospective cohort, neighborhood disadvantage was associated with an increased risk of incident HF events. This increase in HF risk did not differ by diabetes status. Addressing social, economic, and structural factors at the neighborhood level may impact HF prevention.
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Details
- Title
- Neighborhood Disadvantage and Risk of Heart Failure: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study
- Creators
- Gargya Malla - University of Alabama at BirminghamD Leann Long - University of Alabama at BirminghamAndrea Cherrington - University of Alabama at BirminghamParag Goyal - Cornell CollegeBoyi Guo - University of Alabama at BirminghamMonika M Safford - Cornell CollegeYulia Khodneva - University of Alabama at BirminghamDoyle M Cummings - East Carolina UniversityTara P McAlexander - Drexel UniversityShanika DeSilva - Department of Epidemiology and Biostatistics, Drexel University, Philadelphia, Pennsylvania (T.P.M., S.D.)Suzanne E Judd - University of Alabama at BirminghamBertha Hidalgo - University of Alabama at BirminghamEmily B Levitan - University of Alabama at BirminghamApril P Carson - University of Mississippi Medical Center
- Publication Details
- Circulation Cardiovascular quality and outcomes, e009867
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Epidemiology and Biostatistics
- Web of Science ID
- WOS:001233669400006
- Scopus ID
- 2-s2.0-85188100722
- Other Identifier
- 991021852058904721
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- Collaboration types
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Cardiac & Cardiovascular Systems