Neighborhood characteristics and outcomes in patients with atrial fibrillation: A large cohort study in the Midwest

Abstract

Background

The communities in which people live may affect their health.

Objective

The purpose of this study was to investigate the relationship between neighborhood characteristics and outcomes in patients with atrial fibrillation (AF).

Methods

Between 2013 and 2017, patients with new-onset AF were identified from a 27-county region. Addresses were linked to population density (rural–urban commuting area [RUCA] categorized as urban, large town, small town, and isolated rural) and neighborhood socioeconomic status (area deprivation index [ADI] categorized into quartiles of the national percentile rankings). Cox regression determined associations between RUCA and ADI with outcomes (ascertained through 2021). Analyses were restricted to 90-day survivors.

Results

Among 13,233 patients (mean age 73.8 years, 57% men), 744 had an ischemic stroke/transient ischemic attack (TIA), 3077 developed congestive heart failure (CHF), and 5989 died over a mean of 4.6 years. Persons living in isolated areas experienced a higher risk of death compared to urban areas (hazard ratio [HR] 1.14, 95% confidence interval [CI] 1.05–1.24). An increasing risk of death was observed with increasing ADI (HR 1.59, 95% CI 1.37–1.85 for ADI quartile 4 vs 1). When stratified by age, no differences in survival were observed across RUCA or ADI categories for those aged ≥85 years. In individuals aged <65 years, an increased risk of CHF was observed with increasing ADI. There was no association between ischemic stroke/TIA and RUCA categorization or ADI quartile.

Conclusion

Patients with AF living in isolated areas and more socioeconomically disadvantaged regions experience increased risk of death. Understanding this connection is vital for both current and future attempts to mitigate these disparities.