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. 2019 Sep 17;8(18):e012422.
doi: 10.1161/JAHA.119.012422. Epub 2019 Sep 4.

Regional Variation in the Association of Poverty and Heart Failure Mortality in the 3135 Counties of the United States

Khansa Ahmad  1 , Edward W Chen  1 , Umair Nazir  1 , William Cotts  1 , Ambar Andrade  1 , Amal N Trivedi  1 , Sebhat Erqou  1 , Wen-Chih Wu  1
Affiliations

Regional Variation in the Association of Poverty and Heart Failure Mortality in the 3135 Counties of the United States

Khansa Ahmad et al. J Am Heart Assoc. .

Abstract

Background There is significant geographical variation in heart failure (HF) mortality across the United States. County socioeconomic factors that influence these outcomes are unknown. We studied the association between county socioeconomic factors and HF mortality and compared it with coronary heart disease (CHD) mortality. Methods and Results This is a cross-sectional analysis of socioeconomic factors and mortality in HF and CHD across 3135 US counties from 2010 to 2015. County-level poverty, education, income, unemployment, health insurance status, and cause-specific mortality rates were collected from the Centers for Disease Control and Prevention and US Census Bureau databases. Poverty had the strongest correlation with both HF and CHD mortality, disproportionately higher for HF (r=0.48) than CHD (r=0.24). HF mortality increased by 5.2 deaths/100 000 for each percentage increase in county poverty prevalence in a frequency-weighted, demographic-adjusted, multivariate regression model. The greatest attenuation in the poverty regression coefficient (66.4%) was seen after adjustment for prevalence of diabetes mellitus and obesity. Subgroup analysis by census region showed that this relationship was the strongest in the South and weakest in the Northeast (6.1 versus 1.4 deaths/100 000 per 1% increase in county poverty in a demographics-adjusted model). Conclusions County poverty is the strongest socioeconomic factor associated with HF and CHD mortality, an association that is stronger with HF than with CHD and varied by census region. Over half of the association was explained by differences in the prevalence of diabetes mellitus and obesity across the counties. Health policies targeting improvement in these risk factors may address and possibly minimize health disparities caused by socioeconomic factors.

Keywords: disparities; heart failure; mortality; socioeconomic position.

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Figures

Figure 1
Figure 1
Correlation of poverty percentage and mortality and disproportionate association of poverty percentage with heart failure (HF) mortality. Frequency‐weighted scatterplots showing correlation of poverty percentage with HF mortality (A) and coronary heart disease (CHD) mortality (B), across 3135 counties of the United States.
See this image and copyright information in PMC

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