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

IF 2.9 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Peter S. Salama BS , Walker J. Tordsen BS , Sheila M. Manemann MPH , Alvaro Alonso MD, PhD , Peter A. Noseworthy MD, FHRS , Konstantinos C. Siontis MD, FHRS , Bernard J. Gersh MB, ChB, DPhil , Jill M. Killian BS , Susan A. Weston MS , Lisa E. Vaughan MS , Euijung Ryu PhD , Véronique L. Roger MD, MPH , Alanna M. Chamberlain PhD, MPH
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引用次数: 0

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.
心房颤动患者的邻里特征和预后:中西部地区的一项大型队列研究
人们居住的社区可能会影响他们的健康。目的探讨房颤(AF)患者邻里特征与预后的关系。方法2013年至2017年,来自27个县地区的新发房颤患者。地址与人口密度(城乡通勤区域[RUCA]分为城市、大城镇、小城镇和偏远农村)和社区社会经济地位(地区剥夺指数[ADI]分为全国百分位数排名的四分位数)有关。Cox回归确定了RUCA和ADI与结果之间的关联(确定到2021年)。分析仅限于90天的幸存者。结果在13233例患者(平均年龄73.8岁,男性57%)中,744例发生缺血性卒中/短暂性脑缺血发作(TIA), 3077例发生充血性心力衰竭(CHF), 5989例死亡,平均时间4.6年。与城市地区相比,生活在偏远地区的人死亡风险更高(风险比[HR] 1.14, 95%可信区间[CI] 1.05-1.24)。死亡风险随着ADI的增加而增加(ADI四分位数4 vs 1的HR 1.59, 95% CI 1.37-1.85)。当按年龄分层时,对于年龄≥85岁的患者,不同RUCA或ADI类别的生存率无差异。在65岁的人群中,随着每日摄食量的增加,发生CHF的风险增加。缺血性卒中/TIA与RUCA分类或ADI四分位数之间没有关联。结论生活在偏远地区和社会经济条件较差地区的房颤患者死亡风险较高。了解这种联系对于当前和未来减轻这些差异的努力都至关重要。
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来源期刊
Heart Rhythm O2
Heart Rhythm O2 Cardiology and Cardiovascular Medicine
CiteScore
3.30
自引率
0.00%
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0
审稿时长
52 days
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