Associations between neighborhood socioeconomic group and hypertension, diabetes, myocardial infarction and coronary artery disease in a cohort of patients who have undergone cardiac catheterization
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Am Heart J. October 2, 2021: S0002-8703 (21) 00243-X. doi: 10.1016 / j.ahj.2021.09.013. Online ahead of print.
BACKGROUND: Neighborhood socioeconomic status (SES) is associated with health outcomes, including cardiovascular disease (CVD) and diabetes, but these associations are rarely studied in large and diverse populations.
METHODS: We used Ward’s hierarchical clustering to define eight clusters of neighborhoods across North Carolina (NC) using 11 census-based indicators of SES, race, housing, and urbanity. and assigned 6,992 cardiac catheterization patients at Duke University Hospital from 2001 to 2010 to the clusters. We examined associations between clusters and coronary heart disease index> 23 (CAD), history of myocardial infarction (MI), hypertension, and diabetes using logistic regression adjusted for age, race, gender, body mass index, region of NC, distance to Duke Teaching Hospital and smoker status.
RESULTS: Four clusters were urban, three rural, and one upper-middle SES suburban (baseline). We observed a greater likelihood of MI in the six groups with lower or medium SES. The odds of CAD were high in the low SES, predominantly black rural cluster (OR 1.16, 95% CI 0.94-1.43) and in the predominantly Native American rural cluster (OR 1.31, 95% 0.91-1.90). The risks of diabetes and hypertension were high in two urban groups and one rural low and lower middle SES group with large black populations.
CONCLUSIONS: We observed a higher prevalence of cardiovascular disease and diabetes in predominantly rural, low SES, and non-white neighborhoods, highlighting the importance of raising awareness of the public health and health system in these communities to promote cardiometabolic health and preventing and managing hypertension, diabetes and coronary heart disease.
PMID: 34610283 | DOI: 10.1016 / j.ahj.2021.09.013