Neighborhood socioeconomic status linked with heart failure, death for patients with CKD
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Key takeaways:
- Patients with kidney disease and eGFR of at least 45 mL/min/1.73 m2 with the lowest socioeconomic status had increased heart failure risk.
- Myocardial infarction risk increased with lower education level.
Neighborhood socioeconomic status was linked with incident heart failure among patients with chronic kidney disease who had more preserved kidney function, study results showed.
Mortality risk was also associated with socioeconomic status among those younger than 60 years.
“In the general population, there is evidence that neighborhood socioeconomic status (SES) characteristics are associated with cardiovascular risk factors, adverse health outcomes and death,” Avi G. Aronov, MD, of the University of Illinois department of medicine, wrote with colleagues. As a result, “there has been growing interest in evaluating the impact of neighborhood SES on health outcomes among patients with CKD.”
Researchers set out to examine the socioeconomic-cardiovascular relationship among a cohort of 3,197 participants with CKD (eGFR 20 mL/min/1.73 m2 to 70 mL/min/1.73 m2 at enrollment in 2003 to 2008) without cardiovascular disease at baseline as part of the Chronic Renal Insufficiency Cohort Study. The multicenter prospective trial used a validated neighborhood socioeconomic status to measure census-derived variables. Incident heart failure, myocardial infarction and all-cause death were chief outcomes.
There were 465 incident heart failure events, 297 myocardial infarctions and 891 deaths during a median 8.8 years, according to the researchers. Patients with an eGFR of 45 mL/min/1.73 m2 or higher in the lowest neighborhood socioeconomic status quartile had a higher heart failure risk vs. those in the highest quartile (HR, 1.96; 95% CI, 1.04-3.67), according to researchers; however, the association was not significant among those with an eGFR of less than 45 mL/min/1.73 m2.
The researchers observed no association between neighborhood socioeconomic status and myocardial infarction overall. Patients with less than a high school education had a higher myocardial infarction risk (HR, 1.52; 95% CI, 1.06-2.17). Further, in patients younger than 60 years, there was a significant link between the lowest neighborhood socioeconomic status quartile and risk for death (HR, 1.72; 95% CI, 1.06-2.78).
“Our findings emphasize the importance of focusing on both individual- and neighborhood-level socioeconomic factors,” the researchers wrote, “and the need to develop and implement novel health system, public health and public policy interventions to improve cardiovascular outcomes for individuals with CKD residing in disadvantaged communities."
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