• Leah B Rethy, Megan E McCabe, Kiarri N Kershaw, Faraz S Ahmad, Tara Lagu, Lindsay R Pool, and Sadiya S Khan.
• Deparment of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
• J Gen Intern Med. 2021 Dec 1; 36 (12): 371937273719-3727.

BackgroundNeighborhood-level characteristics, such as poverty, have been associated with risk factors for heart failure (HF), including hypertension and diabetes mellitus. However, the independent association between neighborhood poverty and incident HF remains understudied.ObjectiveTo evaluate the association between neighborhood poverty and incident HF using a "real-world" clinical cohort.DesignRetrospective cohort study of electronic health records from a large healthcare network. Individuals' residential addresses were geocoded at the census-tract level and categorized by poverty tertiles based on American Community Survey data (2007-2011).ParticipantsPatients from Northwestern Medicine who were 30-80 years, free of cardiovascular disease at index visit (January 1, 2005-December 1, 2013), and followed for at least 5 years.Main MeasuresThe association of neighborhood-level poverty tertile (low, intermediate, and high) and incident HF was analyzed using generalized linear mixed effect models adjusting for demographics (age, sex, race/ethnicity) and HF risk factors (body mass index, diabetes mellitus, hypertension, smoking status).Key ResultsOf 28,858 patients included, 75% were non-Hispanic (NH) White, 43% were men, 15% lived in a high-poverty neighborhood, and 522 (1.8%) were diagnosed with incident HF. High-poverty neighborhoods were associated with a 1.80 (1.35, 2.39) times higher risk of incident HF compared with low-poverty neighborhoods after adjustment for demographics and HF risk factors.ConclusionsIn a large healthcare network, incident HF was associated with neighborhood poverty independent of demographic and clinical risk factors. Neighborhood-level interventions may be needed to complement individual-level strategies to prevent and curb the growing burden of HF.© 2021. Society of General Internal Medicine.

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