Poverty linked to higher death rates from heart failure
A study in the United States demonstrates that mortality rates from heart failure are higher in counties where people face more poverty and social deprivation.
Heart failure, sometimes called congestive heart failure, is a chronic condition in which the heart is unable to pump enough blood around the body to meet its needs.
The condition is irreversible, although there are treatments that can help people live longer, more active lives.
About 5.7 million people in the U.S. have heart failure, according to the National Heart, Lung, and Blood Institute.
A new study suggests that the risk of dying from the condition is not spread evenly across the country, but that mortality rates are higher in poorer, more socially deprived areas.
Researchers at University Hospitals Cleveland Medical Center, OH, analyzed 1,254,991 deaths from heart failure across 3,048 counties between 1999 and 2018.
They used two standard indices of social deprivation: the Area Deprivation Index (ADI), which takes into account multiple local measures, including employment, poverty, and education, and the Social Deprivation Index (SDI), which is based on income and housing.
After adjusting for age, they found that the average death rate from heart failure per county was 25.5 deaths per 100,000 head of population.
However, counties with higher rates of socioeconomic deprivation had higher death rates from heart failure, and the association held up regardless of race or ethnicity, sex, and degree of urbanization.
The levels of deprivation that the ADI measures accounted for roughly 13% of the variability in heart failure mortality among counties. This scale of risk is similar to that of other recognized risk factors for heart failure, such as obesity and diabetes, say the scientists. Correlation with housing and income — the social factors that the SDI measures — accounted for 5% of this variability.
The research revealed that the imbalance in survival rates between wealthy and deprived areas changed little between 1999 and 2018.
“Analysis of trends in heart failure mortality shows that these disparities have persisted throughout the last two decades,” says first author Dr. Graham Bevan, a resident physician at University Hospitals.
Bevan and his colleagues say that a range of factors may be responsible for the increased risk of dying from heart failure in poorer counties. These include reduced access to healthcare, substandard care, and poor health literacy.
They also note that the successful treatment of heart failure is dependent on patients adhering to a complex and often expensive drug regimen.
The authors write:
“Regardless of the contributing factors, the association between communities with high socioeconomic deprivation and [heart failure] mortality is strong and suggests that targeting social deprivation may be impactful in reducing [heart failure] mortality. Additionally, the yield of intensive [heart failure] preventive strategies may be higher in areas with high social deprivation.”
The American Heart Association (AHA) believe that aggressively tackling the major clinical risk factors for heart failure could significantly reduce the death toll. These clinical factors include hypertension, heart attacks, obesity, diabetes, and disorders of the heart valves.
“Living in a particular county should not mean you’re more likely to die from heart failure,” says co-author Dr. Sadeer G. Al-Kindi, a cardiologist at University Hospitals’ Harrington Heart and Vascular Institute.
“University Hospitals has a history of addressing healthcare disparities in underserved communities and, armed with the information from this study, we can thoughtfully create solutions to better serve these populations.”
One of the limitations of their study, the authors write, was that it relied on the information given on death certificates, which may not be accurate in every instance.
Also, the study was not designed to tease apart the effects of other recognized risk factors for heart failure mortality, some of which — such as lack of physical activity, obesity, diabetes, and high blood pressure — may also be associated with poverty. However, a recent study showed that these factors together failed to account for 57% of the geographical variation in deaths from heart failure among counties in the U.S.
This new study suggests that socioeconomic deprivation may help explain part of that variation.