PDF(Pubmed)
Abstract：
Heart failure (HF) affects >6 million US adults, with recent increases in HF hospitalizations. We aimed to investigate the association between neighborhood disadvantage and incident HF events and potential differences by diabetes status.
We included 23 645 participants from the REGARDS study (Reasons for Geographic and Racial Differences in Stroke), a prospective cohort of Black and White adults aged ≥45 years living in the continental United States (baseline 2005-2007). Neighborhood disadvantage was assessed using a Z score of 6 census tract variables (2000 US Census) and categorized as quartiles. Incident HF hospitalizations or HF-related deaths through 2017 were adjudicated. Multivariable-adjusted Cox regression was used to examine the association between neighborhood disadvantage and incident HF. Heterogeneity by diabetes was assessed using an interaction term.
The mean age was 64.4 years, 39.5% were Black adults, 54.9% females, and 18.8% had diabetes. During a median follow-up of 10.7 years, there were 1125 incident HF events with an incidence rate of 3.3 (quartile 1), 4.7 (quartile 2), 5.2 (quartile 3), and 6.0 (quartile 4) per 1000 person-years. Compared to adults living in the most advantaged neighborhoods (quartile 1), those living in neighborhoods in quartiles 2, 3, and 4 (most disadvantaged) had 1.30 (95% CI, 1.06-1.60), 1.36 (95% CI, 1.11-1.66), and 1.45 (95% CI, 1.18-1.79) times greater hazard of incident HF even after accounting for known confounders. This association did not significantly differ by diabetes status (interaction P=0.59). For adults with diabetes, the adjusted incident HF hazards comparing those in quartile 4 versus quartile 1 was 1.34 (95% CI, 0.92-1.96), and it was 1.50 (95% CI, 1.16-1.94) for adults without diabetes.
In this large contemporaneous prospective cohort, neighborhood disadvantage was associated with an increased risk of incident HF events. This increase in HF risk did not differ by diabetes status. Addressing social, economic, and structural factors at the neighborhood level may impact HF prevention.
We included 23 645 participants from the REGARDS study (Reasons for Geographic and Racial Differences in Stroke), a prospective cohort of Black and White adults aged ≥45 years living in the continental United States (baseline 2005-2007). Neighborhood disadvantage was assessed using a Z score of 6 census tract variables (2000 US Census) and categorized as quartiles. Incident HF hospitalizations or HF-related deaths through 2017 were adjudicated. Multivariable-adjusted Cox regression was used to examine the association between neighborhood disadvantage and incident HF. Heterogeneity by diabetes was assessed using an interaction term.
The mean age was 64.4 years, 39.5% were Black adults, 54.9% females, and 18.8% had diabetes. During a median follow-up of 10.7 years, there were 1125 incident HF events with an incidence rate of 3.3 (quartile 1), 4.7 (quartile 2), 5.2 (quartile 3), and 6.0 (quartile 4) per 1000 person-years. Compared to adults living in the most advantaged neighborhoods (quartile 1), those living in neighborhoods in quartiles 2, 3, and 4 (most disadvantaged) had 1.30 (95% CI, 1.06-1.60), 1.36 (95% CI, 1.11-1.66), and 1.45 (95% CI, 1.18-1.79) times greater hazard of incident HF even after accounting for known confounders. This association did not significantly differ by diabetes status (interaction P=0.59). For adults with diabetes, the adjusted incident HF hazards comparing those in quartile 4 versus quartile 1 was 1.34 (95% CI, 0.92-1.96), and it was 1.50 (95% CI, 1.16-1.94) for adults without diabetes.
In this large contemporaneous prospective cohort, neighborhood disadvantage was associated with an increased risk of incident HF events. This increase in HF risk did not differ by diabetes status. Addressing social, economic, and structural factors at the neighborhood level may impact HF prevention.
摘要：
■心力衰竭（HF）影响>600万美国成年人，随着最近HF住院人数的增加。我们的目的是调查社区劣势与突发HF事件之间的关联以及糖尿病状态的潜在差异。
■我们纳入了来自REGARDS研究（中风的地理和种族差异的原因）的23645名参与者，美国大陆≥45岁黑人和白人成年人的前瞻性队列(基线2005-2007).使用6个人口普查范围变量（2000年美国人口普查）的Z评分评估邻里劣势，并归类为四分位数。截至2017年，已裁定发生HF住院治疗或HF相关死亡。多变量调整后的Cox回归用于检查邻域劣势与突发HF之间的关联。使用相互作用术语评估糖尿病的异质性。
■平均年龄为64.4岁，39.5%是黑人成年人，54.9%女性,18.8%患有糖尿病。在10.7年的中位随访中，有1125例HF事件，发生率为3.3（四分位数1），4.7（四分位数2），5.2（四分位数3），和6.0（四分位数4）每1000人年。与生活在最有利社区(四分位数1)的成年人相比，居住在四分位数2、3和4（最不利）的社区中的人有1.30（95％CI，1.06-1.60），1.36（95%CI，1.11-1.66），和1.45倍（95％CI，1.18-1.79），即使在考虑已知的混杂因素后，发生HF的风险也要大。这种关联在糖尿病状态之间没有显着差异（相互作用P=0.59）。对于患有糖尿病的成年人，与四分位数4和四分位数1相比，调整后的HF风险为1.34（95％CI，0.92-1.96），无糖尿病的成人为1.50(95%CI,1.16-1.94).
■在这个大型同期前瞻性队列中，邻里劣势与HF事件的风险增加相关.HF风险的增加与糖尿病状态没有区别。解决社会问题，经济,和结构因素在邻域水平可能影响HF预防。
■我们纳入了来自REGARDS研究（中风的地理和种族差异的原因）的23645名参与者，美国大陆≥45岁黑人和白人成年人的前瞻性队列(基线2005-2007).使用6个人口普查范围变量（2000年美国人口普查）的Z评分评估邻里劣势，并归类为四分位数。截至2017年，已裁定发生HF住院治疗或HF相关死亡。多变量调整后的Cox回归用于检查邻域劣势与突发HF之间的关联。使用相互作用术语评估糖尿病的异质性。
■平均年龄为64.4岁，39.5%是黑人成年人，54.9%女性,18.8%患有糖尿病。在10.7年的中位随访中，有1125例HF事件，发生率为3.3（四分位数1），4.7（四分位数2），5.2（四分位数3），和6.0（四分位数4）每1000人年。与生活在最有利社区(四分位数1)的成年人相比，居住在四分位数2、3和4（最不利）的社区中的人有1.30（95％CI，1.06-1.60），1.36（95%CI，1.11-1.66），和1.45倍（95％CI，1.18-1.79），即使在考虑已知的混杂因素后，发生HF的风险也要大。这种关联在糖尿病状态之间没有显着差异（相互作用P=0.59）。对于患有糖尿病的成年人，与四分位数4和四分位数1相比，调整后的HF风险为1.34（95％CI，0.92-1.96），无糖尿病的成人为1.50(95%CI,1.16-1.94).
■在这个大型同期前瞻性队列中，邻里劣势与HF事件的风险增加相关.HF风险的增加与糖尿病状态没有区别。解决社会问题，经济,和结构因素在邻域水平可能影响HF预防。
