Abstract 13714: Mortality Among Individuals With Prevalent Heart Failure and Low Socioeconomic Position

Abstract

Introduction: Individuals of low socioeconomic position are at greatest risk for incident heart failure (HF). Few data exist, however, regarding factors associated with mortality among individuals with prevalent HF and low socioeconomic position. Methods: The Southern Community Cohort Study (SCCS) is a prospective observational study of 84,797 individuals of predominantly low socioeconomic position enrolled between 2002 to 2009 from 12 states in the southeastern US. Using Cox regression models, we examined demographic, social determinants, and clinical factors associated with 5-year all-cause mortality in a subset of 4,309 black or white adults with prevalent HF receiving Centers for Medicare and Medicaid Services at enrollment. Death was ascertained through linkage with the National Death Index and cohort follow-up. Results: Individuals with prevalent HF at SCCS enrollment were predominantly middle age (mean ~59 years), female (64%), black (70%), low income (75% <$15k/year), and low education (46% < high school). Over 5-year follow up, a total of 975 (23%) individuals died. Older individuals and men were at greater risk of death. Comorbidities such as history of myocardial infarction/coronary bypass, diabetes, hypertension, and smoking significantly associated with greater risk of death, as did lower physical activity and greater sedentary time. In contrast, social determinants such as race, income, education, and rural vs. urban residence did not significantly associate with mortality. Overall, body mass index (BMI) accounted for the greatest proportion of variance in the risk of death with a non-linear, predominantly inverse association ( Figure ). Conclusions: Among individuals of low socioeconomic position with prevalent heart failure residing in the southeastern US, clinical factors, particularly BMI, account for risk of mortality more so than social determinants.