Neighborhood Socioeconomic Disadvantage and Mortality Among Medicare Beneficiaries Hospitalized for Acute Myocardial Infarction, Heart Failure, and Pneumonia

Hermes, Zachary; Maddox, Karen E. Joynt; Yeh, Robert W.; Zhao, Yuansong; Shen, Changyu; Wadhera, Rishi K.

doi:10.1007/s11606-021-07090-z

Cited by 15 publications

(16 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…34 The etiology of these inequities is multifactorial but likely includes disparities in early-life exposures, access to health care, and other factors rooted in structural racism. 35 Scalable and realistic solutions are needed. The expansion of tailored community-based programs (eg, pharmacist-led interventions in Black barbershops) 36 and large-scale health system initiatives that screen for and treat uncontrolled blood pressure for young Black adults, 37 in combination with efforts to address socioeconomic factors (eg, poverty), community factors (eg, access to primary care), and environmental factors (eg, green space for regular exercise), could help reduce disparities in hypertension for this population.…”

Section: Discussionmentioning

confidence: 99%

“…Black adults have high rates of stroke, heart failure, and hypertensive kidney disease, as well as the highest premature cardiovascular mortality rates in the country, in part due to a high burden of hypertension . The etiology of these inequities is multifactorial but likely includes disparities in early-life exposures, access to health care, and other factors rooted in structural racism . Scalable and realistic solutions are needed.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Cardiovascular Risk Factor Prevalence, Treatment, and Control in US Adults Aged 20 to 44 Years, 2009 to March 2020

Aggarwal

Yeh

Maddox

et al. 2023

JAMA

Self Cite

View full text Add to dashboard Cite

ImportanceDeclines in cardiovascular mortality have stagnated in the US over the past decade, in part related to worsening risk factor control in older adults. Little is known about how the prevalence, treatment, and control of cardiovascular risk factors have changed among young adults aged 20 to 44 years.ObjectiveTo determine if the prevalence of cardiovascular risk factors (hypertension, diabetes, hyperlipidemia, obesity, and tobacco use), treatment rates, and control changed among adults aged 20 to 44 years from 2009 through March 2020, overall and by sex and race and ethnicity.Design, Setting, and ParticipantsSerial cross-sectional analysis of adults aged 20 to 44 years in the US participating in the National Health and Nutrition Examination Survey (2009-2010 to 2017–March 2020).Main Outcomes and MeasuresNational trends in the prevalence of hypertension, diabetes, hyperlipidemia, obesity, and smoking history; treatment rates for hypertension and diabetes; and blood pressure and glycemic control in those receiving treatment.ResultsAmong 12 924 US adults aged 20 to 44 years (mean age, 31.8 years; 50.6% women), the prevalence of hypertension was 9.3% (95% CI, 8.1%-10.5%) in 2009-2010 and 11.5% (95% CI, 9.6%-13.4%) in 2017-2020. The prevalence of diabetes (from 3.0% [95% CI, 2.2%-3.7%] to 4.1% [95% CI, 3.5%-4.7%]) and obesity (from 32.7% [95% CI, 30.1%-35.3%] to 40.9% [95% CI, 37.5%-44.3%]) increased from 2009-2010 to 2017-2020, while the prevalence of hyperlipidemia decreased (from 40.5% [95% CI, 38.6%-42.3%] to 36.1% [95% CI, 33.5%-38.7%]). Black adults had high rates of hypertension across the study period (2009-2010: 16.2% [95% CI, 14.0%-18.4%]; 2017-2020: 20.1% [95% CI, 16.8%-23.3%]), and significant increases in hypertension were observed among Mexican American adults (from 6.5% [95% CI, 5.0%-8.0%] to 9.5% [95% CI, 7.3%-11.7%]) and other Hispanic adults (from 4.4% [95% CI, 2.1%-6.8%] to 10.5% [95% CI, 6.8%-14.3%]), while Mexican American adults had a significant rise in diabetes (from 4.3% [95% CI, 2.3%-6.2%] to 7.5% [95% CI, 5.4%-9.6%]). The percentage of young adults treated for hypertension who achieved blood pressure control did not significantly change (from 65.0% [95% CI, 55.8%-74.2%] in 2009-2010 to 74.8% [95% CI, 67.5%-82.1%] in 2017-2020], while glycemic control among young adults receiving treatment for diabetes remained suboptimal throughout the study period (2009-2010: 45.5% [95% CI, 27.7%-63.3%]) to 2017-2020: 56.6% [95% CI, 39.2%-73.9%]).Conclusions and RelevanceIn the US, diabetes and obesity increased among young adults from 2009 to March 2020, while hypertension did not change and hyperlipidemia declined. There was variation in trends by race and ethnicity.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Cardiovascular Risk Factor Prevalence, Treatment, and Control in US Adults Aged 20 to 44 Years, 2009 to March 2020

Aggarwal

Yeh

Maddox

et al. 2023

JAMA

Self Cite

View full text Add to dashboard Cite

show abstract

“…ADI also serves as a proxy for individual social risk factors such as economic stability and the built environment of the neighborhood, which are social determinants of health 14 and have the potential for implications for value-based reimbursement. 28 In the general population, ADI has been associated with surgical and medical outcomes, 6 health care utilization, 19 and hospital readmission, 29 while in solid tumor cancer patients it has been associated with survival 7 and anxiety. 30 Our findings suggest that among long-term survivors of BMT, ADI is associated not only with self-reported routine health care utilization, but also with self-reported health, even after accounting for chronic health conditions, individual-level sociodemographics, and time since routine check-up.…”

Section: Discussionmentioning

confidence: 99%

“…Residing in a neighborhood characterized by socioeconomic disadvantage has been associated with poorer health outcomes, such as increased comorbidity burden and premature mortality. 1 , 2 , 3 , 4 For example, neighborhood disadvantage has been associated with general surgical 5 and medical 6 outcomes, as well as outcomes among cancer patients with solid tumors. 7 …”

Section: Introductionmentioning

confidence: 99%

Neighborhood disadvantage, health status, and health care utilization after blood or marrow transplant: BMTSS report

et al. 2023

View full text Add to dashboard Cite

Living in a disadvantaged neighborhood is associated with poor health outcomes. Blood or Marrow Transplant (BMT) survivors remain at risk of chronic health conditions requiring anticipatory management. We hypothesized that among BMT survivors, neighborhood disadvantage was associated with poor self-reported routine healthcare utilization and health. We leveraged data from BMTSS - a retrospective cohort study examining long-term outcomes among individuals surviving ≥2y following BMT at three institutions between 1974-2014. Participants in this analysis completed the BMTSS survey (sociodemographics; chronic health conditions; time since routine check-up; self-reported health). The Area Deprivation Index (ADI) represented neighborhood disadvantage; this composite indicator of 17 census measures is a percentile rank (0=least deprived to 100=most deprived). Multivariable ordered logit regression adjusted for clinical factors and individual-level sociodemographics, modeling associations between ADI, time since routine check-up, and self-reported health. Among 2,857 survivors, median ADI was 24 (interquartile range: 10-46). Adjusting for self-reported individual-level socioeconomic indicators and chronic health conditions, patients in more disadvantaged neighborhoods had higher odds of reporting longer intervals since routine check-up (ORADI_continuous=1.007, p<0.001) and poorer health status (controlling for time since check-up; ORADI_continuous=1.005, p=0.003). Compared to patients living in the least disadvantaged neighborhood (ADI=1), patients in the most disadvantaged neighborhood (ADI=100), had twice the odds (ORADI=1.007^99=2.06) of reporting no routine visits and 1.65-times the odds of reporting poor health (ORADI=1.005^99=1.65). In BMT survivors, access to healthcare and health status are associated with area disadvantage. These findings may inform strategies to address long-term care coordination and retention for vulnerable survivors.

show abstract

“…The ADI has been used broadly, and increasing neighborhood deprivation has been associated with hospital readmissions, cause-specific mortality, and the development of atherosclerotic cardiovascular disease. In addition to our group’s work in the YOUNG-MI cohort, Hermes et al have recently demonstrated the independent association of socioeconomic disadvantage as measured by the ADI with 30-day mortality rates after an admission for acute myocardial infarction in nearly 3.5 million Medicare beneficiaries . Taken together, these findings reinforce that neighborhood-level socioeconomic factors are independent risk factors for poor cardiovascular outcomes.…”

mentioning

confidence: 83%

Role of Income-Lifting Social Programs in Reducing Years of Life Lost to Myocardial Infarction and Sudden Death—Reply

2022

View full text Add to dashboard Cite

To the Editor We appreciate the work of Berman and colleagues, 1 who investigated the association between socioeconomic disadvantage and mortality after a myocardial infarction (MI). The authors found that among people who had an MI before age 50 years, patients who lived in the most disadvantaged neighborhoods had a higher risk of all-cause and cardiovascular mortality. These findings suggest that addressing socioeconomic disadvantage among working-age adults may be key to reducing years of life lost to cardiovascular diseases. This is also highlighted in the Invited Commentary by Havranek. 2 The SUDDEN research group has previously found that living in a low-median household income census tract or a rural census tract was associated with a higher incidence of sudden death. 3 Together, the findings from the SUDDEN research group and Berman et al 1 suggest socioeconomic status is an important risk factor for mortality in working-age adults beyond other sociodemographic variables and clinical comorbidities. We posit that identifying specific areas of policy that affect populations of interest is crucial to positive change. We appreciate the insights of Havranek 2 regarding clinician advocacy and the role of health care centers in creating equitable systems. We additionally believe that government programs that provide income support can help reduce disparities in cardiovascular outcomes. Socioeconomic status may have been underestimated as an independent factor in cardiovascular outcomes in the past in favor of individual comorbidities. Recent research has shed light on how socioeconomic factors can trigger or exacerbate traditional risks, like hypertension and dyslipidemia.Socioeconomic factors are therefore reasonable leverage points for combatting disparities. Targeted income-raising interventions, such as child tax credits, Medicaid expansion, and the Supplemental Nutrition Assistance Program (SNAP), are important tools for public health professionals and clinicians. 4 Although the federally funded SNAP has seen funding increases in the wake of the COVID-19 pandemic, it had been under attack for some time prior to the pandemic. The future of SNAP and other income-support programs should continue to be of concern. 5 Based on prior SUDDEN research, we believe increased eligibility for SNAP benefits could help to reduce the incidence of sudden death in working-age adults. 3 We expect that the recent increases in SNAP benefits will lead to improved outcomes in the coming years, which will demonstrate the population health benefits of this program beyond the initial nutritional benefits to children and families. We urge readers to consider that socioeconomic status is of utmost importance as a prevention pathway for mortality in workingage adults.

show abstract

Neighborhood Socioeconomic Disadvantage and Mortality Among Medicare Beneficiaries Hospitalized for Acute Myocardial Infarction, Heart Failure, and Pneumonia

Cited by 15 publications

References 38 publications

Cardiovascular Risk Factor Prevalence, Treatment, and Control in US Adults Aged 20 to 44 Years, 2009 to March 2020

Cardiovascular Risk Factor Prevalence, Treatment, and Control in US Adults Aged 20 to 44 Years, 2009 to March 2020

Neighborhood disadvantage, health status, and health care utilization after blood or marrow transplant: BMTSS report

Role of Income-Lifting Social Programs in Reducing Years of Life Lost to Myocardial Infarction and Sudden Death—Reply

Contact Info

Product

Resources

About