row houses in Baltimore

Where you live may affect how you fare after heart failure

Living in a low-income neighborhood may raise the risk that heart patients will be readmitted to the hospital.

“The association between neighborhood SES (socioeconomic status) and outcomes of patients with heart disease has been under investigation for two decades,” says Behnood Bikdeli, a research scholar at Yale Center for Outcomes Research and Evaluation.

Neighborhood characteristics such as noise, air pollution, crime, and access to healthy foods and exercise facilities are tied to neighborhood socioeconomic status.

“The central question has been whether low neighborhood SES represents as a marker of higher risk, or is independently associated with higher risk of adverse outcomes.”

Bikdeli and colleagues studied more than 1,500 patients with heart failure and found that low neighborhood SES was linked to higher rates of hospital readmissions for all causes six months after initial hospital admission.

Bikdeli says this is not surprising because prior studies have shown similar findings, but this recent study focused on information about individual demographics, clinical characteristics, co-morbidities, medications, and individual SES.

Neighborhood-level factors

“We demonstrated that the impact of neighborhood of residence persisted even after stepwise adjustments for all individual-level factors,” says Bikdeli. “In a broader sense, our study highlights that a wide array of factors that may impact disease outcomes.

“Although there may be some interrelation between individual and neighborhood characteristics, we believe that individual factors and neighborhood-level factors can independently impact the outcomes of patients with chronic conditions such as heart failure.”

Bikdeli says a crucial next step in the research is to test whether changing the modifiable neighborhood characteristics would help improve patient outcomes.

“In order to prevent readmission, we may need to focus on neighborhood factors, as well as individual patient factors,” he says.

The study was published in Circulation: Cardiovascular Quality and Outcomes.

Source: Yale University