Association of neighborhood-level material deprivation with adverse outcomes and processes of care among patients with heart failure in a single-payer healthcare system: a population-based cohort study

Background — We studied the association between neighborhood material deprivation, a metric estimating inability to attain basic material needs, with outcomes and processes of care among incident heart failure (HF) patients in a universal healthcare system.

Methods — In a population-based retrospective study (2007-2019), we examined the association of material deprivation with one-year all-cause mortality, cause-specific hospitalization, and 90-day processes of care. Using cause-specific hazards regression we quantified the relative rate of events after multiple covariate adjustment, stratifying by age ≤65 or ≥66 years.

Results — Among 395,763 patients (median age 76 [IQR 66-84] years, 47% women), there was significant interaction between age and deprivation quintile for mortality/hospitalization outcomes (P≤0.001). Younger residents (age ≤65 years) of the most versus least deprived neighborhoods had higher hazards of all-cause death (HR 1.19 [95%CI, 1.10-1.29]) and cardiovascular hospitalization (HR 1.29 [95%CI, 1.19-1.39]). Older individuals (≥66 years) in the most deprived neighbourhoods had significantly higher hazard of death (HR 1.11 [95%CI, 1.08-1.14]) and cardiovascular hospitalization (HR 1.13 [95%CI, 1.09-1.18]) compared to the least deprived. The magnitude of the association between deprivation and outcomes was amplified in the younger compared to the older age group. More deprived individuals in both age groups had a lower hazard of cardiology visits and advanced cardiac imaging (all P<0.001), while the most deprived of younger ages were less likely to undergo ICD/CRT-P implantation (P=0.023), compared to the least deprived.

Conclusion — Patients with newly-diagnosed HF residing in the most deprived neighborhoods had worse outcomes and reduced access to care than those less deprived.