Abstract P079: Disparities in Heart Failure in Older Age: Do Individual or Neighbourhood Measures of Deprivation Affect Incidence Over a 10-Year Follow-up?

Abstract

Background: Few studies have examined the prospective associations between socioeconomic measures and incident heart failure, and in particular effects of neighbourhood deprivation. The aim of this study was to investigate the association of socioeconomic measures (individual and neighbourhood-level) with incident heart failure in older adults and to examine possible underlying pathways. Methods: A socially and geographically representative cohort of men aged 60-79 years in 1998-2000 from 24 British towns was followed for 10 years for incident heart failure (fatal and non-fatal based on death certificates and doctor-diagnosis). Individual-level socioeconomic measures included longest-held occupational social class, education, pension (state only or state with private), and amenities (car and house ownership, access to central heating) - a cumulative score of adverse socioeconomic measures from 0 to ≥4 was used. Index of multiple deprivation (IMD) was the small area-level socioeconomic measure (based on income, employment, health, housing, education, access to services and crime) grouped into quintiles of increasing deprivation. Prevalent myocardial infarctions and heart failures were excluded.Results: Among 3839 men, 232 incident cases of heart failure occurred over 10 years. Heart failure risk increased with increasing cumulative score of adverse (individual-level) socioeconomic measures (p for trend=0.0006). Compared to men with a score of 0, the hazard ratio for men with a score of ≥4 was 2.19 (95%CI 1.34-3.55) which weakened to 1.99 (95%CI 1.16-3.45), but remained significant after adjusting for neighbourhood deprivation (IMD), systolic blood pressure, body mass index, smoking, HDL-cholesterol, diabetes and lung function. Adjustment for left ventricular hypertrophy, atrial fibrillation, heart rate and renal function made little difference. Further adjustment for C-reactive protein, von Willebrand Factor and plasma vitamin C slightly weakened the hazard ratio to 1.78 (95%CI 1.01-3.13). Hazard ratio per IMD quintile (neighbourhood deprivation) was 1.04 (95%CI 0.95-1.14). Conclusions: Disparities in heart failure in older populations need to be addressed - the risk of heart failure in older age was greater in the lowest socioeconomic groups, which was only partly explained by established and novel risk factors for heart failure. This increased risk of heart failure according to individual-level socioeconomic measures was independent of neighbourhood-level deprivation. Neighbourhood level deprivation does not in itself appear to influence risk of heart failure.