Neighborhood characteristics—not just individual socioeconomic standing—could have a significant impact on the cardiovascular health of a community and its residents, reports a study published this week in Circulation: Cardiovascular Quality and Outcomes.
Prior research has established the influence social class can have on a person’s heart health. Through various trials, researchers have proven those living below the poverty line—who have less access to healthy, affordable food and experience economic and social stressors beyond a normal threshold—are more likely to suffer from cardiovascular disease. Recent data, though, has suggested a further correlation between neighborhood socioeconomic factors and residents’ hospital admissions, particularly for cardiac issues.
A research team led by Elvis A. Akwo, MD, PhD, analyzed 27,078 middle-aged individuals living in low-income neighborhoods in America’s “heart failure belt,” which stretches across the Southeastern U.S. Black and white residents were recruited for the study, which compared heart failure rates with census tract data on socioeconomic deprivation. Variables like housing patterns, distribution of wealth, education levels and occupation all drove results.
Of the participant pool, nearly 39 percent had less than a high school education and 44 percent were obese. Seventy percent of residents earned less than $15,000 a year, and more than half were living in their area’s most deprived neighborhoods.
During more than five years of follow-up, Akwo and colleagues found 4,300 participants had been diagnosed with heart failure. After adjusting for socioeconomic factors, the researchers reported 4.8 percent of all variance in heart-failure risk among the population studied could be explained by neighborhood factors.
“These findings support the position of several cardiovascular societies suggesting that upstream interventions encompassing preventive measures and public policy, namely improvements in community-level resources (and) particularly in areas with acute neighborhood deprivation, may have a wide-reaching population-level effect on the mitigation of adverse cardiovascular outcomes including heart failure,” the authors wrote in Circulation.
Wayne Rosamond, PhD, MS, and Anna Johnson, PhD, MSPH, wrote in an accompanying editorial that Akwo et al.’s work challenges the medical community to think about effective, neighborhood-level interventions that could reduce the rate of cardiovascular disease in poorer areas.
The American government's 2020 impact goals could benefit from knowledge like this, they wrote.
“It seems reasonable to consider that to achieve bold goals such as a 20 percent improvement in cardiovascular health in all Americans, a better understanding of the elements of one’s neighborhood that contribute to these health factors and behaviors is severely needed,” Rosamond and Johnson said. “One might argue that neighborhood metrics themselves could be added to future definitions of cardiovascular health. Work by Akwo et al. challenges us to think of new ways to broaden our definition of ‘neighborhood’ to better characterize and respond to the complex systems and underlying mechanisms of the effect of home on heart.”