Neighbourhood‐level social deprivation and the risk of recurrent heart failure hospitalizations in type 2 diabetes

Abstract

AbstractBackgroundThe importance of type 2 diabetes mellitus (T2D) in heart failure hospitalizations (HFH) is acknowledged. As information on the prevalence and influence of social deprivation on HFH is limited, we studied this issue in a racially diverse cohort.MethodsLinking data from US Veterans with stable T2D (without prevalent HF) with a zip‐code derived population‐level social deprivation index (SDI), we grouped them according to increasing SDI as follows: SDI: group I: ≤20; II: 21‐40; III: 41‐60; IV: 61‐80; and V (most deprived) 81‐100. Over a 10‐year follow‐up period, we identified the total (first and recurrent) number of HFH episodes for each patient and calculated the age‐adjusted HFH rate [per 1000 patient‐years (PY)]. We analysed the incident rate ratio between SDI groups and HFH using adjusted analyses.ResultsIn 1 012 351 patients with T2D (mean age 67.5 years, 75.7% White), the cumulative incidence of first HFH was 9.4% and 14.2% in SDI groups I and V respectively. The 10‐year total HFH rate was 54.8 (95% CI: 54.5, 55.2)/1000 PY. Total HFH increased incrementally from SDI group I [43.3 (95% CI: 42.4, 44.2)/1000 PY] to group V [68.6 (95% CI: 67.8, 69.9)/1000 PY]. Compared with group I, group V patients had a 53% higher relative risk of HFH. The negative association between SDI and HFH was stronger in Black patients (SDI × Race pinteraction < .001).ConclusionsSocial deprivation is associated with increased HFH in T2D with a disproportionate influence in Black patients. Strategies to reduce social disparity and equalize racial differences may help to bridge this gap.