By American Heart Association News

People living in deprived neighborhoods have a higher risk of heart failure regardless of their socioeconomic status, according to a new study.

Past research has linked heart failure with a person’s individual socioeconomic status, a general term which includes income, education and occupation. But the new study, published Tuesday in Circulation: Cardiovascular Quality and Outcomes, shows that deprived neighborhoods themselves may play a role in higher heart failure rates.

“Simply put, it matters where you live,” said the study’s lead author Dr. Elvis Akwo, a postdoctoral research fellow at Vanderbilt University Medical Center in Nashville. “Improving a person’s individual condition isn’t enough.”

Rather, ramping up community-level resources may have a more significant and wide-reaching impact on preventing conditions such as heart failure, he said.

Akwo and fellow researchers at Vanderbilt sought to find out if a neighborhood deprivation index — a cluster of 11 social and economic factors — can predict the risk of heart failure beyond individual socioeconomic status in a low-income population. The study included 27,078 whites and blacks living in low-income neighborhoods who were recruited as part of the Southern Community Cohort Study, a study of chronic diseases in the southeastern United States.

Participants were predominantly middle-aged and poor: 70 percent earned less than $15,000 a year. They were put into three groups, ranging from the least-deprived to the most-deprived neighborhoods.

During five years of follow-up, 4,300 participants were diagnosed with heart failure, and nearly 5 percent of the increased heart failure risk in deprived areas could be attributed to neighborhood factors.

“That’s an important finding,” Akwo said. “Even after controlling for an individual’s clinical and economic status, we still saw a higher risk of heart failure among people living in areas that are socioeconomically deprived. Your neighborhood does make a difference.”

“This kind of study means that to generate solutions, we have to go outside of medicine. We have to delve into sociological and environmental circumstances,” said Dr. Clyde Yancy, a cardiologist at Northwestern Memorial Hospital and the chief of cardiology at Northwestern University Feinberg School of Medicine in Chicago.

Yancy, who was not involved in the study, called the paper a “significant, deep analysis that gives us more clarity about what we can and we cannot do.” He said that to improve people’s heart health, our society desperately needs to improve neighborhoods that don’t have good access to health care providers, education, healthy foods and decent housing.

“To make a difference, we’ll have to develop and engage with social interventionists. That’s probably a brand new phrase in the lexicon of cardiovascular disease … but studies like this force the conversation to go deeper,” Yancy said.

Previous studies suggest deprived neighborhoods are not very exercise-friendly, which may be a contributing factor to the increased risk of heart failure, Akwo said. “There may be a lower density of physical exercise resources, and safety concerns may further limit the use of outdoor recreations facilities,” he said.

Heart failure is on the rise in the U.S., affecting more than 6 million adults as of 2014. By 2030, that number is expected to surpass 8 million.

While most of the study participants were black (69 percent), Yancy said it is important to note that researchers did not focus on race.

“A decade ago, the entirety of this paper would have been predicated on black versus white, and you would have walked away thinking black Americans, for inexplicable reasons, seemingly have a greater burden of heart failure,” Yancy said. “This study changes the narrative. It makes us pause for a minute and begin to talk about what is it in the environment, per se, that seems to be associated with greater or less likelihood of disease.”

Yancy and Akwo agreed that further studies are needed to pinpoint the best approaches for improving heart health in poor neighborhoods. Yancy said the new study is likely to have a positive impact on those future studies — especially when it comes to the challenging topic of race and heart disease.

“It tells us that race is a placeholder for something, and that the unsettling anxiety it creates when we are forced to discuss race in a clinical setting may not be necessary,” Yancy said. “This kind of work gives us more illumination and much-needed insight. It provides a direction.”

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