Abstract
Background: Regional poverty has been associated with worse outcomes in stroke, myocardial infarction and overall cardiovascular mortality. There is paucity of data regarding regional socioeconomic (SE) factors and outcomes in heart failure (HF). We studied the association between SE factors and HF mortality and compared it with CHD mortality at a regional level. Methods: This is a cross sectional analysis of all US counties (n=3141) from 2010-2015. County level data for SE factors, risk factor prevalence and demographics were collected from CDC and Census Bureau. Counties (n=6) with insufficient mortality data were excluded. In 2014, poverty threshold was $11,670 for 1-person household. Mortality data was derived from death certificates, published by National Center for Health Statistics. Random sampling (n=50) was used to compare the strength of correlation for the strongest SE factor (poverty, employment, education and uninsured %) with HF and CHD mortality. Population weighted multivariate linear regression analyses were used to relate the strongest SE factor and HF mortality, adjusted for risk factor prevalence and demographics. Results: We studied 3,135 counties with median(IQR) of poverty (15.8% (12.4% - 20.1%)), male (49.5% (48.9% -50.4%)), white (84.6% (63.4% -93.1%), ≥ 65 yrs. (17.2% (14.7%-19.9%)), number of HF hospitalizations/1000 Medicare beneficiaries (13.9 (9.2-17.6)) and HF deaths/100,000 (189.5 (164.7-219.1)). Of all SE factors, poverty% has the strongest association with HF mortality, disproportionately higher for HF than CHD (p=0.000). Our final model explains 61.7% of variation in regional HF mortality. Poverty remains an independent risk factor despite adjusting for demographics, other SE factors and risk factor prevalence. Conclusion: County poverty disproportionately effects HF mortality as compared to CHD mortality, independent of demographics and risk factor prevalence. Future studies examining additional mechanism of this association are needed to reform health policy.
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