Heart failure deaths are highest in the poorest U.S. counties

Study Highlights:

• Death rates from heart failure are higher in counties with higher levels of poverty.
• The link between county poverty and heart failure mortality was largely explained by the prevalence of diabetes and obesity.

Embargoed until 4 a.m. CT / 5 a.m. ET, Wednesday, Sept. 4, 2019

DALLAS, Sept. 4, 2019 — People living in counties with high rates of poverty are more likely to die from heart failure compared to people living in more affluent areas, according to new research published in Journal of the American Heart Association, the Open Access Journal of the American Heart Association.

“When you look at a map of the United States, you will see that the poorer counties have the highest death rates from heart failure,” said Khansa Ahmad, M.D., the study’s lead author and a preventive cardiology fellow at the Alpert Medical School of Brown University in Providence, Rhode Island. Heart failure is a chronic, progressive condition in which the heart muscle is unable to pump enough blood to meet the body’s needs for blood and oxygen.

To explore geographical differences, the researchers reviewed data from 3,000 United States counties looking for potential links between heart failure deaths and county-level poverty, education, unemployment and health insurance status. Data was pulled from the Centers of Disease Control and Census Bureau databases. They found:

• County-level poverty had the strongest correlation with heart failure deaths.
• Heart failure deaths increased by about five deaths per 100,000 for each 1% increase in county poverty status.
• A difference of approximately 250 deaths per 100,000 between the poorest and the most affluent counties was observed.
• About two thirds of the relationship between country poverty and heart failure deaths was explained by the prevalence of diabetes and obesity across the counties.
• The link between poverty and heart failure deaths was the strongest in counties in the southern census region.  

“Interventions to help people in poor areas, where obesity is more common, to attain and maintain a healthy body weight should be investigated in developing policies to improve heart failure outcomes across the US counties,” said Wen-Chih Wu, M.D., study co-author and chief of cardiology and research health science at the Providence VA Medical Center and associate professor of medicine at Brown University. 

“This study underscores the disparities in healthcare faced by many Americans. As healthcare providers, we need to understand the barriers to a healthy lifestyle faced by patients, such as living in areas with no access to healthy food or safe places to walk. Understanding these barriers and helping our patients overcome them is the first step towards building trust and better serving our under-resourced communities,” said Jennifer Ellis, M.D., M.B.A., chief of Cardiothoracic Surgery at NYC Health + Hospitals/Bellevue in New York, New York and advisor to the American Heart Association’s EmPOWERED to Serve ™ , a platform for people who are passionate about closing disparity gaps through health justice initiatives in their community.

The American Heart Association is working to break these links through community action plans that address specific issues, like obesity, food deserts and access to care in poor communities across the U.S. 

Co-authors are Edward W. Chen, Sc.B.; Umair Nazir, M.D.; William Cotts, M.D.; Ambar Andrade, M.D.; Amal N Trivedi, M.D., M.P.H.; and Sebhat Erqou, M.D., Ph.D. No author disclosures.

Providence VA Medical Center, The Miriam Hospital and Brown University supported the study.

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