Association Between Neighborhood-Level Poverty and Incident Atrial Fibrillation: a Retrospective Cohort Study

Abstract

BACKGROUND: Atrial fibrillation (AF) is a leading cause of cardiovascular morbidity and mortality. While neighborhood-level factors, such as poverty, have been related to prevalence of AF risk factors, the association between neighborhood poverty and incident AF has been limited. OBJECTIVE: Using a large cohort from a health system serving the greater Chicago area, we sought to determine the association between neighborhood-level poverty and incident AF. DESIGN: Retrospective cohort study. PARTICIPANTS: Adults, aged 30 to 80 years, without baseline cardiovascular disease from January 1, 2005, to December 31, 2018. MAIN MEASURES: We geocoded and matched residential addresses of all eligible patients to census-level poverty estimates from the American Community Survey. Neighborhood-level poverty (low, intermediate, and high) was defined as the proportion of residents in the census tract living below the federal poverty threshold. We used generalized linear mixed effects models with a logit link function to examine the association between neighborhood poverty and incident AF, adjusting for patient demographic and clinical AF risk factors. KEY RESULTS: Among 28,858 in the cohort, patients in the high poverty group were more often non-Hispanic Black or Hispanic and had higher rates of AF risk factors. Over 5 years of follow-up, 971 (3.4%) patients developed incident AF. Of these, 502 (51.7%) were in the low poverty, 327 (33.7%) in the intermediate poverty, and 142 (14.6%) in the high poverty group. The adjusted odds ratio (aOR) of AF was higher for the intermediate poverty compared with that for the low poverty group (aOR 1.23 [95% CI 1.01-1.48]). The point estimate for the aOR of AF incidence was similar, but not statistically significant, for the high poverty compared with the low poverty group (aOR 1.25 [95% CI 0.98-1.59]). CONCLUSION: In adults without baseline cardiovascular disease managed in a large, integrated health system, intermediate neighborhood poverty was significantly associated with incident AF. Understanding neighborhoodlevel drivers of AF disparities will help achieve equitable care.

Heart Disease and Stroke Statistics—2023 Update: A Report From the American Heart Association

“…In an analysis of a large regional health care system, individuals (N=28 858) living in intermediate-poverty neighborhoods (as defined by census tract-level variables) had higher adjusted odds of 5-year incident AF (OR, 1.23 [95% CI, 1.01–1.48]) compared with those residing in lower-poverty neighborhoods. 115…”

Atrial Fibrillation Inpatient Management Patterns and Clinical Outcomes During The Conflict In Syria: An Observational Cohort Study

“…There has been a significant increase in AF prevalence in low-income countries in the last 20 years (8). The Syrian population have been living in poverty and life stress for the previous ten years, both of which are suggested to promote AF (4,9). 9 This inpatient cohort is relatively younger than patients admitted in high-income countries.…”

“…As a result, less than half of its hospitals operate at full performance, with over 50% of its healthcare workforce forced to leave due to conflict. More than half the Syrian population live in poverty, which is suggested to increase AF risk (4). The AF management in hospitals during the accompanying political and economic turmoil is unclear, with a lack of published inpatient outcomes and figures originating from Syrian hospitals.…”

Whose Streets? Neighborhood-Level Determinants of Atrial Fibrillation Care

“…These findings are consistent with other studies from Denmark, Sweden, and the United States that have examined the relationship between neighborhood factors such as income, education, and area deprivation, on AF incidence, treatment, and outcomes (Figure ). [3][4][5][6][7][8] The Abdel-Qadir analysis also further demonstrates that although Ontarians receive their medical care from a universal health system, disparities in AF treatment still existed. These findings are much like those observed in AF management in the US Veterans Healthcare Administration, another universal health system.…”