Can Neighborhood Conditions Predict the Risk of Heart Failure?

Heart failure is a rampant public health concern across America, especially in the southeastern United States. Prior research suggests that heart failure and its related health risk factors (such as coronary heart disease, high blood pressure, diabetes, and obesity) are associated with income and educational attainment. Emerging research suggests that neighborhood conditions may also contribute to an increased risk of heart failure. To better understand the influence of neighborhood conditions on heart health, this study analyzed how neighborhood quality predicts heart failure outcomes among low-income Black and white populations in the southeastern United States.

To conduct the study, researchers analyzed a sample from the Southern Community Cohort Study (SCCS), which explored the incidence of a variety of chronic conditions among 84,747 low-income, underinsured adults ages 40 to 79. The SCCS recruited from community health centers across 12 southeastern states between 2002 and 2009 and recorded demographic, socioeconomic, lifestyle, body measurement, and personal medical history data. Using these data, researchers pulled a sample of 27,078 SCCS participants who were covered by Medicaid or Medicare and who self-reported as Black or non-Hispanic white. Then researchers looked at the combination of medical claims data for the incidence of heart failure among participants and US Census Bureau data for social or economic indicators of neighborhood deprivation at the census-tract level. The neighborhood deprivation index (NDI) includes 11 variables, such as the percent of households experiencing crowding or severe housing cost burden, the poverty rate, median home value, educational attainment, and unemployment rate. Researchers then analyzed the association between NDI and the first incidence of heart failure among participants over the course of the study.

Within the study sample, the mean age was 55, 69 percent of participants were Black, 63 percent were female, 70 percent earned less than $15,000 a year, and more than half (60 percent) lived in the most deprived neighborhoods. Participants living in the most deprived neighborhoods were more likely to be younger, Black, and obese and were more likely to smoke, have less than a high school education, and earn less than $15,000 a year, compared with those living in the least deprived neighborhoods. They were also more likely to report a history of diabetes and hypertension at the beginning of the study. The median amount of time a participant was enrolled in the study was 5.2 years. The results are described in person-years, which shows heart failure events not just across the population studied but across the studied population for each year of the study.

Key findings

• Over the course of the study, 4,300 participants (16 percent) of the sample experienced heart failure.
• Participants living in the most socioeconomically deprived neighborhoods had the highest incidence rate of heart failure, at 37.9 per 1,000 person-years, compared with 28.4 per 1,000 person-years among those living in the least socioeconomically deprived neighborhoods.
• Higher levels of neighborhood deprivation were significantly associated with an increase in heart failure risk, independent of individual socioeconomic and health factors.
• After adjusting for demographic, lifestyle, and clinical factors, moving from the 1st to 3rd quartile on the neighborhood deprivation index was associated with a 12 percent increase in risk of heart failure.
• Neighborhood deprivation explained 4.8 percent of the variance in increased heart failure risk.
• Neighborhood deprivation had more influence on the risk of heart failure among white participants than Black participants. An increase in neighborhood deprivation from the 1st to 3rd quartile on the index was associated with a 20 percent increase in risk of heart failure among white participants and a 10 percent increase among Black participants.

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