Residing in the most versus least deprived neighbourhoods was associated with higher 1-year all-cause mortality in younger (HR 1.19; 95% CI 1.10-1.29) and older (HR 1.11; 95% CI 1.08-1.14) patients.
Cohort (n=395,763)
Does neighbourhood-level material deprivation increase adverse outcomes and reduce access to care in patients with incident heart failure?
Neighbourhood material deprivation is associated with worse clinical outcomes and reduced access to specialized care in patients with newly diagnosed heart failure, particularly among younger patients.
Hazard Ratio: 1.19 (95% CI 1.1–1.29)
AIM: We studied the association between neighbourhood material deprivation, a metric estimating inability to attain basic material needs, with outcomes and processes of care among incident heart failure patients in a universal healthcare system. METHODS AND RESULTS: In a population-based retrospective study (2007-2019), we examined the association of material deprivation with 1-year all-cause mortality, cause-specific hospitalization, and 90-day processes of care. Using cause-specific hazards regression, we quantified the relative rate of events after multiple covariate adjustment, stratifying by age ≤65 or ≥66 years. Among 395 763 patients (median age 76 interquartile range 66-84 years, 47% women), there was significant interaction between age and deprivation quintile for mortality/hospitalization outcomes (p ≤ 0.001). Younger residents (age ≤65 years) of the most versus least deprived neighbourhoods had higher hazards of all-cause death (hazard ratio HR 1.19, 95% confidence interval CI 1.10-1.29]) and cardiovascular hospitalization (HR 1.29 95% CI 1.19-1.39). Older individuals (≥66 years) in the most deprived neighbourhoods had significantly higher hazard of death (HR 1.11 95% CI 1.08-1.14) and cardiovascular hospitalization (HR 1.13 95% CI 1.09-1.18) compared to the least deprived. The magnitude of the association between deprivation and outcomes was amplified in the younger compared to the older age group. More deprived individuals in both age groups had a lower hazard of cardiology visits and advanced cardiac imaging (all p < 0.001), while the most deprived of younger ages were less likely to undergo implantable cardioverter-defibrillator/cardiac resynchronization therapy-pacemaker implantation (p = 0.023), compared to the least deprived. CONCLUSION: Patients with newly-diagnosed heart failure residing in the most deprived neighbourhoods had worse outcomes and reduced access to care than those less deprived.
Bobrowski et al. (Mon,) conducted a cohort in Incident heart failure (n=395,763). Neighbourhood-level material deprivation vs. Least deprived neighbourhoods was evaluated on 1-year all-cause death (age ≤65 years) (HR 1.19, 95% CI 1.10-1.29). Residing in the most versus least deprived neighbourhoods was associated with higher 1-year all-cause mortality in younger (HR 1.19; 95% CI 1.10-1.29) and older (HR 1.11; 95% CI 1.08-1.14) patients.
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