Akwo Elvis A, Kabagambe Edmond K, Harrell Frank E, Blot William J, Bachmann Justin M, Wang Thomas J, Gupta Deepak K, Lipworth Loren
From the Division of Epidemiology, Department of Medicine (E.A.A., E.K.K., W.J.B., L.L.), Department of Biostatistics (F.E.H.), Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt Heart and Vascular Institute (J.M.B., T.J.W., D.K.G.), and Vanderbilt Translational and Clinical Cardiovascular Research Center (V-TRACC) (E.A.A., E.K.K., F.E.H., J.M.B., T.J.W., D.K.G., L.L.), Vanderbilt University School of Medicine, Nashville, TN.
Circ Cardiovasc Qual Outcomes. 2018 Jan;11(1):e004052. doi: 10.1161/CIRCOUTCOMES.117.004052.
Recent data suggest that neighborhood socioeconomic environment predicts heart failure (HF) hospital readmissions. We investigated whether neighborhood deprivation predicts risk of incident HF beyond individual socioeconomic status in a low-income population.
Participants were 27 078 whites and blacks recruited during 2002 to 2009 in the SCCS (Southern Community Cohort Study), who had no history of HF and were using Centers for Medicare or Medicaid Services. Incident HF diagnoses through December 31, 2010, were ascertained using , Ninth Revision, codes 428.x via linkage with Centers for Medicare or Medicaid Services research files. Participant residential information was geocoded and census tract determined by a spatial join to the US Census Bureau TIGER/Line Shapefiles. 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 HF risk. The study sample was predominantly middle aged (mean, 55.5 years), black (69%), female (63%), low income (70% earned <$15 000/y), and >50% of participants lived in the most deprived neighborhoods (third neighborhood deprivation index tertile). Over median follow-up of 5.2 years, 4300 participants were diagnosed with HF. After adjustment for demographic, lifestyle, and clinical factors, a 1 interquartile increase in neighborhood deprivation index was associated with a 12% increase in risk of HF (hazard ratio, 1.12; 95% confidence interval, 1.07-1.18), and 4.8% of the variance in HF risk (intraclass correlation coefficient, 4.8; 95% confidence interval, 3.6-6.4) was explained by neighborhood deprivation.
In this low-income population, scant neighborhood resources compound the risk of HF above and beyond individual socioeconomic status and traditional cardiovascular risk factors. Improvements in community resources may be a significant axis for curbing the burden of HF.
近期数据表明，社区社会经济环境可预测心力衰竭（HF）患者再次入院情况。我们调查了在低收入人群中，除个体社会经济地位外，社区贫困状况是否可预测新发HF风险。
研究对象为2002年至2009年期间在南方社区队列研究（SCCS）中招募的27078名白人和黑人，这些人无HF病史且使用医疗保险或医疗补助服务中心的数据。通过与医疗保险或医疗补助服务中心研究文件进行关联，使用国际疾病分类第九版（ICD-9）编码428.x确定截至2010年12月31日的新发HF诊断。通过空间连接美国人口普查局TIGER/Line Shapefiles对参与者的居住信息进行地理编码并确定普查区。基于普查区层面的社会经济变量，采用主成分分析构建社区贫困指数。使用带有Huber-White聚类三明治方差估计器的Cox模型研究社区贫困指数与HF风险之间的关联。研究样本以中年为主（平均年龄55.5岁），黑人占69%，女性占63%，低收入者占70%（年收入<$15000），超过50%的参与者生活在贫困程度最高的社区（社区贫困指数三分位数中的第三分位）。在中位随访5.2年期间，4300名参与者被诊断为HF。在对人口统计学、生活方式和临床因素进行调整后，社区贫困指数每增加1个四分位数间距，HF风险增加12%（风险比，1.12；95%置信区间，1.07 - 1.18），社区贫困可解释HF风险中4.8%的变异（组内相关系数，4.8；95%置信区间，3.6 - 6.4）。
在这一低收入人群中，社区资源匮乏会使HF风险在个体社会经济地位和传统心血管危险因素之外进一步增加。改善社区资源可能是减轻HF负担的一个重要方面。
