Abstract P658: Redlining, Neighborhood Vulnerability, and Heart Failure Outcomes Among Patients in the Southeastern US

Abstract

Introduction: Disparities in heart failure (HF) outcomes are due, in part, to social determinants of health. Structural racism is thought to be a fundamental cause of health disparities. A form of structural racism, redlining, was instituted in the 1930s to disinvest in neighborhoods with a high concentration of racial and ethnic minorities, leading to neighborhoods marred by crime, poverty, and disrepair. While studies have focused on how the contemporary neighborhood impacts health outcomes, few studies have examined how historical racist policies have shaped cardiovascular disease outcomes. Additionally, no studies have focused exclusively on the Southeastern region of the US where rates of cardiovascular disease and HF are among the highest in the country. This analysis examined the association between redlining and HF outcomes (e.g., 30-day readmission and mortality) among HF patients residing in Georgia. Hypothesis: Patients residing in “definitely declining” and “hazardous” neighborhoods will have a higher risk of both 30-day readmission and 30-day mortality compared to patients residing in “best” defined neighborhoods. Methods: Data are from a retrospective cohort of patients hospitalized for acute HF within Emory Healthcare from 2010 to 2018. Patient addresses were geocoded and linked to historically redlined neighborhoods at the census tract level using Home Owners’ Loan Corporation (HOLC) maps which classified neighborhoods as: “best”, “still desirable”, “definitely declining”, or “hazardous/redlined”. Neighborhood deprivation was assessed at the census tract level using the Social Vulnerability Index. Multivariable logistic regression was used to estimate the relative risk of 30-day readmission and 30-day mortality across HOLC-graded neighborhoods adjusted for patient demographics, clinical and hospital characteristics, and neighborhood deprivation. Results: Within the full sample, redlining was not associated with either 30-day readmission (RR 0.90; 95% CI: 0.62, 1.31) or mortality (RR 1.32; 95% CI: 0.79, 2.20). Redlining was not associated with 30-day mortality among Black patients. However, residing in a historically redlined neighborhood appeared to be associated with a two-fold increased risk in 30-day readmission for Black patients although results were non-significant (RR 1.98; 95% CI: 0.52, 7.59). Conclusion: In conclusion, redlining was not associated with HF readmission or mortality across racial groups. Findings among Black patients suggest that redlining may be associated with adverse heart failure outcomes. Further research with larger samples is needed.