Regional Variation in the Association of Poverty and Heart Failure Mortality in the 3135 Counties of the United States
Background There is significant geographical variation in heart failure (HF) mortality across the United States. County socioeconomic factors that influence these outcomes are unknown. We studied the association between county socioeconomic factors and HF mortality and compared it with coronary hear...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2019-09-01
|
| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.119.012422 |
| _version_ | 1819183293984145408 |
|---|---|
| author | Khansa Ahmad Edward W. Chen Umair Nazir William Cotts Ambar Andrade Amal N. Trivedi Sebhat Erqou Wen‐Chih Wu |
| author_facet | Khansa Ahmad Edward W. Chen Umair Nazir William Cotts Ambar Andrade Amal N. Trivedi Sebhat Erqou Wen‐Chih Wu |
| author_sort | Khansa Ahmad |
| collection | DOAJ |
| description | Background There is significant geographical variation in heart failure (HF) mortality across the United States. County socioeconomic factors that influence these outcomes are unknown. We studied the association between county socioeconomic factors and HF mortality and compared it with coronary heart disease (CHD) mortality. Methods and Results This is a cross‐sectional analysis of socioeconomic factors and mortality in HF and CHD across 3135 US counties from 2010 to 2015. County‐level poverty, education, income, unemployment, health insurance status, and cause‐specific mortality rates were collected from the Centers for Disease Control and Prevention and US Census Bureau databases. Poverty had the strongest correlation with both HF and CHD mortality, disproportionately higher for HF (r=0.48) than CHD (r=0.24). HF mortality increased by 5.2 deaths/100 000 for each percentage increase in county poverty prevalence in a frequency‐weighted, demographic‐adjusted, multivariate regression model. The greatest attenuation in the poverty regression coefficient (66.4%) was seen after adjustment for prevalence of diabetes mellitus and obesity. Subgroup analysis by census region showed that this relationship was the strongest in the South and weakest in the Northeast (6.1 versus 1.4 deaths/100 000 per 1% increase in county poverty in a demographics‐adjusted model). Conclusions County poverty is the strongest socioeconomic factor associated with HF and CHD mortality, an association that is stronger with HF than with CHD and varied by census region. Over half of the association was explained by differences in the prevalence of diabetes mellitus and obesity across the counties. Health policies targeting improvement in these risk factors may address and possibly minimize health disparities caused by socioeconomic factors. |
| first_indexed | 2024-12-22T22:59:44Z |
| format | Article |
| id | doaj.art-925665a815064bceac0aafd242a6986d |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-22T22:59:44Z |
| publishDate | 2019-09-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-925665a815064bceac0aafd242a6986d2022-12-21T18:09:43ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802019-09-0181810.1161/JAHA.119.012422Regional Variation in the Association of Poverty and Heart Failure Mortality in the 3135 Counties of the United StatesKhansa Ahmad0Edward W. Chen1Umair Nazir2William Cotts3Ambar Andrade4Amal N. Trivedi5Sebhat Erqou6Wen‐Chih Wu7Division of Cardiology, Providence Veterans Affairs Medical Center and the Warren Alpert Medical School at Brown University Providence RIDivision of Cardiology, Providence Veterans Affairs Medical Center and the Warren Alpert Medical School at Brown University Providence RIDivision of Cardiology, Providence Veterans Affairs Medical Center and the Warren Alpert Medical School at Brown University Providence RIDivision of Cardiology, Providence Veterans Affairs Medical Center and the Warren Alpert Medical School at Brown University Providence RIDivision of Cardiology, Providence Veterans Affairs Medical Center and the Warren Alpert Medical School at Brown University Providence RIDivision of Cardiology, Providence Veterans Affairs Medical Center and the Warren Alpert Medical School at Brown University Providence RIDivision of Cardiology, Providence Veterans Affairs Medical Center and the Warren Alpert Medical School at Brown University Providence RIDivision of Cardiology, Providence Veterans Affairs Medical Center and the Warren Alpert Medical School at Brown University Providence RIBackground There is significant geographical variation in heart failure (HF) mortality across the United States. County socioeconomic factors that influence these outcomes are unknown. We studied the association between county socioeconomic factors and HF mortality and compared it with coronary heart disease (CHD) mortality. Methods and Results This is a cross‐sectional analysis of socioeconomic factors and mortality in HF and CHD across 3135 US counties from 2010 to 2015. County‐level poverty, education, income, unemployment, health insurance status, and cause‐specific mortality rates were collected from the Centers for Disease Control and Prevention and US Census Bureau databases. Poverty had the strongest correlation with both HF and CHD mortality, disproportionately higher for HF (r=0.48) than CHD (r=0.24). HF mortality increased by 5.2 deaths/100 000 for each percentage increase in county poverty prevalence in a frequency‐weighted, demographic‐adjusted, multivariate regression model. The greatest attenuation in the poverty regression coefficient (66.4%) was seen after adjustment for prevalence of diabetes mellitus and obesity. Subgroup analysis by census region showed that this relationship was the strongest in the South and weakest in the Northeast (6.1 versus 1.4 deaths/100 000 per 1% increase in county poverty in a demographics‐adjusted model). Conclusions County poverty is the strongest socioeconomic factor associated with HF and CHD mortality, an association that is stronger with HF than with CHD and varied by census region. Over half of the association was explained by differences in the prevalence of diabetes mellitus and obesity across the counties. Health policies targeting improvement in these risk factors may address and possibly minimize health disparities caused by socioeconomic factors.https://www.ahajournals.org/doi/10.1161/JAHA.119.012422disparitiesheart failuremortalitysocioeconomic position |
| spellingShingle | Khansa Ahmad Edward W. Chen Umair Nazir William Cotts Ambar Andrade Amal N. Trivedi Sebhat Erqou Wen‐Chih Wu Regional Variation in the Association of Poverty and Heart Failure Mortality in the 3135 Counties of the United States Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease disparities heart failure mortality socioeconomic position |
| title | Regional Variation in the Association of Poverty and Heart Failure Mortality in the 3135 Counties of the United States |
| title_full | Regional Variation in the Association of Poverty and Heart Failure Mortality in the 3135 Counties of the United States |
| title_fullStr | Regional Variation in the Association of Poverty and Heart Failure Mortality in the 3135 Counties of the United States |
| title_full_unstemmed | Regional Variation in the Association of Poverty and Heart Failure Mortality in the 3135 Counties of the United States |
| title_short | Regional Variation in the Association of Poverty and Heart Failure Mortality in the 3135 Counties of the United States |
| title_sort | regional variation in the association of poverty and heart failure mortality in the 3135 counties of the united states |
| topic | disparities heart failure mortality socioeconomic position |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.119.012422 |
| work_keys_str_mv | AT khansaahmad regionalvariationintheassociationofpovertyandheartfailuremortalityinthe3135countiesoftheunitedstates AT edwardwchen regionalvariationintheassociationofpovertyandheartfailuremortalityinthe3135countiesoftheunitedstates AT umairnazir regionalvariationintheassociationofpovertyandheartfailuremortalityinthe3135countiesoftheunitedstates AT williamcotts regionalvariationintheassociationofpovertyandheartfailuremortalityinthe3135countiesoftheunitedstates AT ambarandrade regionalvariationintheassociationofpovertyandheartfailuremortalityinthe3135countiesoftheunitedstates AT amalntrivedi regionalvariationintheassociationofpovertyandheartfailuremortalityinthe3135countiesoftheunitedstates AT sebhaterqou regionalvariationintheassociationofpovertyandheartfailuremortalityinthe3135countiesoftheunitedstates AT wenchihwu regionalvariationintheassociationofpovertyandheartfailuremortalityinthe3135countiesoftheunitedstates |