US Heart Failure Mortality Rates Vary by County Income Levels

A new study is illustrating the disparity between death, heart failure rates, and the wealth of an area can impact the odds of a patient’s survival.

Results of the study, which used data from the Centers of Disease Control and the Census Bureau, found a difference of about 250 deaths per 100,000 between the poorest and most affluent counties in the United States.

"This study underscores the disparities in healthcare faced by many Americans,” said Jennifer Ellis, MD, chief of cardiothoracic surgery at NYC Health + Hospitals. “As healthcare providers, we need to understand the barriers to a healthy lifestyle faced by patients, such as living in areas with no access to healthy food or safe places to walk. Understanding these barriers and helping our patients overcome them is the first step towards building trust and better serving our under-resourced communities.”

In an effort to better understand how geographical differences could play a role in deaths from heart failure and coronary heart disease (CHD), investigators conducted a cross-sectional analysis of data from 3135 US counties from 2010 to 2015. From the CDC and Census Bureau databases, investigators obtained county-level poverty, education, income, unemployment, health insurance status, and cause-specific mortality rates.

Analyses performed adjusted for diabetes mellitus and obesity. Additionally, investigators adjusted for smoking status, physical inactivity, and medication adherence patterns.

Upon analysis, the median poverty percentage was 15.8%, median heart failure mortality was 189.5 per 100,000, and median CHD mortality was 208 per 100,000. County-level poverty prevalence correlated with both heart failure mortality (r=0.48; 95% CI, 0.45 to 0.51) and CHD mortality (r=0.24; 95% CI, 0.20 to 0.27) (P<0.001).

In a demographic-adjusted model, investigators found an increase of 5.2 heart failure deaths per 100,000 for each percentage increase in county poverty — this correlates with a difference of 254.8 deaths per 100,000 when comparing the county with the lowest poverty prevalence to the county with the highest.

The greatest attenuation in poverty regression coefficient (66.4%) was noted after adjustment for prevalence of diabetes mellitus and obesity. Subgroup analyses by census region showed this relationship was strongest in southern regions and weakest in the northeast.

"When you look at a map of the United States, you will see that the poorer counties have the highest death rates from heart failure," said lead author Khansa Ahmad, MD, a preventive cardiology fellow at the Alpert Medical School of Brown University.

This study, “Regional Variation in the Association of Poverty and Heart Failure Mortality in the 3135 Counties of the United States,” was published online in the Journal of the American Heart Association.