Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
Department of Biostatistics and Bioinformatics, Emory Rollins School of Public Health, Atlanta, Georgia.
Am J Cardiol. 2021 Feb 1;140:83-90. doi: 10.1016/j.amjcard.2020.10.057. Epub 2020 Nov 2.
Residence in socioeconomically deprived neighborhoods may influence patient's health-related behaviors and overall health. We evaluated the association of neighborhood disadvantage on heart failure (HF) symptom burden and hospitalization rates. We characterized neighborhood deprivation in 359 HF subjects (age 56 ± 13 years, 52% black) in metropolitan Atlanta using the Area Deprivation Index (ADI). ANOVA was used to compare HF symptoms measured using the Kansas City Cardiomyopathy Questionnaire, and HF Self-Care Index across ADI tertiles. Zero-inflated Poisson regression was used to compare rates of recurrent HF hospitalization (HFH) across ADI tertiles. Subjects living in more deprived neighborhoods were more likely to be black, have Medicare or Medicaid insurance, and have a lower ejection fraction than those living in less deprived neighborhoods (all p ≤ 0.005). Subjects in more deprived neighborhoods had more severe HF symptoms (p < 0.001), but there was no difference in HF Self-Care Index scores across ADI tertiles. Subjects living in more deprived neighborhoods had a higher odds of being hospitalized for HF than subjects in less deprived neighborhoods. Once subjects had experienced a HFH, however, the association between ADI and the risk of recurrent HFH varied by racial group. In whites, increasing ADI was associated with a marginally decreased risk of recurrent HFH, while there was no association between ADI and recurrent HFH in blacks. In conclusion, patients with HF living in more deprived neighborhoods have greater symptom burden and are more likely to experience a HFH than those living in less deprived neighborhoods.
居住在社会经济贫困的社区可能会影响患者的健康相关行为和整体健康。我们评估了社区劣势对心力衰竭（HF）症状负担和住院率的影响。我们使用区域剥夺指数（ADI）对亚特兰大都会区的 359 名 HF 患者（年龄 56 ± 13 岁，52%为黑人）的社区剥夺情况进行了特征描述。使用方差分析（ANOVA）比较了使用堪萨斯城心肌病问卷（Kansas City Cardiomyopathy Questionnaire）和心力衰竭自我护理指数（HF Self-Care Index）测量的 HF 症状，在 ADI 三分位数之间进行比较。使用零膨胀泊松回归比较了 ADI 三分位数之间复发性 HF 住院率（HFH）的差异。居住在贫困程度较高社区的患者更有可能是黑人，拥有医疗保险或医疗补助，并且射血分数比居住在贫困程度较低社区的患者低（所有 p ≤ 0.005）。居住在贫困程度较高社区的患者 HF 症状更严重（p < 0.001），但在 ADI 三分位数之间 HF Self-Care Index 评分没有差异。居住在贫困程度较高社区的患者因 HF 住院的可能性高于居住在贫困程度较低社区的患者。然而，一旦患者经历了 HFH，ADI 与复发性 HFH 风险之间的关系因种族群体而异。在白人中，ADI 的增加与复发性 HFH 的风险略有降低相关，而在黑人中，ADI 与复发性 HFH 之间没有关联。总之，居住在贫困程度较高社区的 HF 患者比居住在贫困程度较低社区的患者症状负担更大，更有可能经历 HFH。
