BACKGROUND:Heart failure (HF) affects >6 million US adults, with recent increases in HF hospitalizations. We aimed to investigate the association between neighborhood disadvantage and incident HF events and potential differences by diabetes status.METHODS:We included 23 645 participants from the REGARDS study (Reasons for Geographic and Racial Differences in Stroke), a prospective cohort of Black and White adults aged ≥45 years living in the continental United States (baseline 2005–2007). Neighborhood disadvantage was assessed using a Z score of 6 census tract variables (2000 US Census) and categorized as quartiles. Incident HF hospitalizations or HF-related deaths through 2017 were adjudicated. Multivariable-adjusted Cox regression was used to examine the association between neighborhood disadvantage and incident HF. Heterogeneity by diabetes was assessed using an interaction term.RESULTS:The mean age was 64.4 years, 39.5% were Black adults, 54.9% females, and 18.8% had diabetes. During a median follow-up of 10.7 years, there were 1125 incident HF events with an incidence rate of 3.3 (quartile 1), 4.7 (quartile 2), 5.2 (quartile 3), and 6.0 (quartile 4) per 1000 person-years. Compared to adults living in the most advantaged neighborhoods (quartile 1), those living in neighborhoods in quartiles 2, 3, and 4 (most disadvantaged) had 1.30 (95% CI, 1.06–1.60), 1.36 (95% CI, 1.11–1.66), and 1.45 (95% CI, 1.18–1.79) times greater hazard of incident HF even after accounting for known confounders. This association did not significantly differ by diabetes status (interaction P=0.59). For adults with diabetes, the adjusted incident HF hazards comparing those in quartile 4 versus quartile 1 was 1.34 (95% CI, 0.92–1.96), and it was 1.50 (95% CI, 1.16–1.94) for adults without diabetes.CONCLUSIONS:In this large contemporaneous prospective cohort, neighborhood disadvantage was associated with an increased risk of incident HF events. This increase in HF risk did not differ by diabetes status. Addressing social, economic, and structural factors at the neighborhood level may impact HF prevention.

中文翻译：

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社区劣势和心力衰竭风险：中风地理和种族差异的原因（REGARDS）研究

背景：心力衰竭 (HF) 影响超过 600 万美国成年人，最近心力衰竭住院人数有所增加。我们的目的是调查邻里劣势与心力衰竭事件之间的关联以及糖尿病状况的潜在差异。方法：我们纳入了 REGARDS 研究（卒中地理和种族差异的原因）中的 23 645 名参与者，该研究是一个黑人和白人成年人的前瞻性队列居住在美国大陆的年龄≥45岁（基线2005-2007年）。使用6 个人口普查区变量（2000 年美国人口普查）的Z分数评估邻里劣势，并将其分类为四分位数。对 2017 年的心力衰竭住院或心力衰竭相关死亡事件进行了裁决。多变量调整 Cox 回归用于检查邻里劣势与心力衰竭事件之间的关联。使用交互项评估糖尿病的异质性。结果：平均年龄为 64.4 岁，39.5% 为黑人成年人，54.9% 为女性，18.8% 患有糖尿病。在中位随访 10.7 年期间，发生了 1125 起心力衰竭事件，发病率为每 1000 人年 3.3（四分位数 1）、4.7（四分位数 2）、5.2（四分位数 3）和 6.0（四分位数 4） 。与居住在最有利社区（第 1 四分位数）的成年人相比，居住在第 2、3 和 4 四分位数（最弱势）社区的成年人的这一比例为 1.30（95% CI，1.06–1.60）、1.36（95% CI，1.11– 1.66) 和 1.45 (95% CI, 1.18–1.79) 倍，即使考虑了已知的混杂因素，心力衰竭事件的风险也增加了 1.45 倍。这种关联并没有因糖尿病状态而显着不同（交互作用P = 0.59）。对于成人糖尿病患者，第四四分位数与第一四分位数相比，调整后的心力衰竭风险为 1.34（95% CI，0.92–1.96），而对于非糖尿病成人，该风险为 1.50（95% CI，1.16–1.94）。 结论：在这一大型同期前瞻性队列中，邻里劣势与心力衰竭事件风险增加相关。心力衰竭风险的增加并不因糖尿病状况而异。解决社区层面的社会、经济和结构因素可能会影响心力衰竭的预防。