Abstract 17028: Neighborhood Income is Associated With Prevalence of Myocardial Infarction and Heart Failure Independent of Individual Demographic Factors in Densely Populated Urban Seniors
Background: Individual socioeconomic status (SES) is associated with cardiovascular disease (CVD), but few studies have investigated neighborhood SES and CVD. We hypothesized that CVD prevalence may differ by urban neighborhoods even after adjusting for individual SES.
Methods: Adults 59-99 years old from New York City were enrolled in the NHLBI-funded Cardiovascular Health of Seniors and the Built Environment Study from 2009 to 2011 (n=1,453). Geocoded maps using participants addresses were correlated to 2010 US census tract data. Neighborhood median incomes were stratified into the following categories: (highest (H) [$51,712_$160,833], med-high (MH) [$37,084_$51,711], med-low (ML) [$25,615_$37,083], lowest (L) [<$25,615]). Log-linear models generated crude and adjusted (age, race and income) effect estimates.
Results: There were 153 cases of myocardial infarction (MI) and 92 cases of heart failure (HF) detected. Over 90% of participants had health insurance. There was a geographic association between cases and neighborhood SES with most located in lower income census tracts (Figure). In unadjusted models, the prevalence of HF increased incrementally as median income of the area decreased [(MH: RR=1.27, 95% CI 0.65-2.45); (ML: RR= 1.59, 95% CI 0.85 - 2.98); and (L: RR= 2.25, 95% CI 1.24 - 4.05)]. Effect estimates were only moderately attenuated by adjusting for individual factors [(MH: RR= 1.10, 95% CI 0.57-2.15); (ML: RR= 1.27, 95% CI 0.67 - 2.43); and (L: RR= 1.69, 95% CI 0.90 - 3.15)]. Similar dose response effects were observed in adjusted models for MI [(MH: RR= 1.05, 95% CI 0.65-1.69); (ML: RR=1.31, 95% CI 0.83 - 2.07); and (L: RR=1.48, 95% CI 0.93 - 2.34).
Conclusions: This analysis demonstrates an independent effect of neighborhood variation on CVD prevalence irrespective of personal SES among densely populated urban seniors with access to care. Determining the mechanism(s) behind this variation may generate solutions to eliminate this disparity in CVD.
- © 2013 by American Heart Association, Inc.