Neighborhood Socioeconomic Status and Mortality Among Heart Failure Patients

Background Heart failure (HF) is a major public health concern in the USA with high mortality. Although neighborhood-level socioeconomic status (NSES) is associated with adverse health outcomes in the general community, it is unclear if NSES is associated with mortality in HF patients.Methods We used electronic health records from 30,060 heart failure patients seen at a University of North Carolina-affiliated hospital between July 1, 2004 and December 31, 2016. We created indicators for NSES using Ward's hierarchical clustering of ten Census-based measures assessed at the block group level, yielding seven neighborhood clusters across North Carolina (NC). We conducted Cox proportional hazards analysis, adjusting for age, sex, and race, to evaluate differential hazards of mortality across the seven clusters.Results We assigned participants to one of seven clusters based on NSES and urbanicity: urban low-NSES (97% urban, n=3162), urban middle-low-NSES (91% urban, n=5078), urban middle-high-NSES (98% urban, n=2127), urban high-NSES (96% urban, n=5510), rural low-NSES (8% urban, n=2705), rural middle-NSES (13% urban, n=8258), and suburban high-NSES (85% urban, n=3220, referent). Compared to the referent suburban high-NSES cluster, hazards of mortality for HF patients were elevated in the urban middle-high-NSES (HR 1.14, 95% Confidence Interval [CI] 1.03-1.22), rural middle-NSES (HR 1.13, 95% CI 1.05-1.19), and rural low-NSES (HR 1.11, 95% CI 1.01-1.20) clusters. Hazard ratios were less elevated among urban middle-low-NSES (HR 1.08, 95% CI 0.99-1.15), urban low-NSES (HR 1.06, 95% CI 0.96, 1.14), and urban high-NSES (HR 1.06, 95% CI 0.97-1.13) clusters.Conclusions Among HF patients, hazards of mortality were generally more elevated for residents of traditionally understudied rural neighborhood clusters, compared to more urban clusters. Residents of the urban middle-high-NSES cluster had a more elevated hazard than other urban clusters, suggesting that additional factors in this cluster may contribute to mortality. This abstract does not necessarily reflect EPA policies.