Abstract
Purpose
This study examined how certain aspects of residential neighborhood conditions (ie,
observed built environment, census-based area-level poverty, and perceived disorder)
affect readmission in urban patients with heart failure.
Methods
A total of 400 patients with heart failure who were discharged alive from an urban-university
teaching hospital were enrolled. Data were collected about readmissions during a 2-year
follow-up. The impact of residential neighborhood conditions on readmissions was examined
with adjustment for 7 blocks of covariates: 1) patient demographic characteristics;
2) comorbidities; 3) clinical characteristics; 4) depression; 5) perceived stress;
6) health behaviors; and 7) hospitalization characteristics.
Results
A total of 83.3% of participants were readmitted. Participants from high-poverty census
tracts (≥20%) were at increased risk of readmission compared with those from census
tracts with <10% poverty (hazard ratio [HR]: 1.53; 95% confidence interval: 1.03-2.27;
P < .05) when adjusted for demographic characteristics. None of the built environmental
or perceived neighborhood conditions were associated with the risk of readmission.
The poverty-related risk of readmission was reduced to nonsignificance after including
diabetes (HR: 1.33) and hypertension (HR: 1.35) in the models.
Conclusions
The effect of high poverty is partly explained by high rates of hypertension and diabetes
in these areas. Improving diabetes and blood pressure control or structural aspects
of impoverished areas may help reduce hospital readmissions.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The American Journal of MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Who has higher readmission rates for heart failure, and why? Implications for efforts to improve care using financial incentives.Circ Cardiovasc Qual Outcomes. 2011; 4: 53-59
- Heart disease and stroke statistics-2020 update: a report from the American Heart Association.Circulation. 2020; 141: e139-e596
- Neighborhood socioeconomic disadvantage and 30-day rehospitalization.Ann Intern Med. 2014; 161: 765-774
- Utility of socioeconomic status in predicting 30-day outcomes after heart failure hospitalization.Circ Heart Fail. 2015; 8: 473-480
- Potential of community-based risk estimates for improving hospital performance measures and discharge planning.BMJ Open Quality. 2021; 10e001230
- Temporal trends and patterns in heart failure incidence: a population-based study of 4 million individuals.Lancet. 2018; 391: 572-580
- Urban neighborhoods and depressive symptoms among older adults.J Gerontol B: Psychol Sci Soc Sci. 2007; 62: S52-S59
- Neighborhood disadvantage and adult depression.J Health Soc Behav. 2000; 41: 177-187
- Neighborhood disorder and obesity-related outcomes among women in Chicago.Int J Environ Res Public Health. 2018; 15: 1395
- Broken (windows) theory: a meta-analysis of the evidence for the pathways from neighborhood disorder to resident health outcomes and behaviors.Soc Sci Med. 2019; 228: 272-292
- 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC.Eur J Heart Fail. 2016; 18: 891-975
- Using Google Street View to audit the built environment: inter-rater reliability results.Ann Behav Med. 2013; 45: S108-S112
- Disorder and decay: the concept and measurement of perceived neighborhood disorder.Urban Affairs Rev. 1999; 34: 412-432
- The PHQ-9: validity of a brief depression severity measure.J Gen Intern Med. 2001; 16: 606-613
- A brief measure for assessing generalized anxiety disorder: the GAD-7.Arch Intern Med. 2006; 166: 1092-1097
- Psychometric testing of the self-care of heart failure index.J Card Fail. 2004; 10: 350-360
- Relation of living in a “food desert” to recurrent hospitalizations in patients with heart failure.Am J Cardiol. 2019; 123: 291-296
- Depression and multiple rehospitalizations in patients with heart failure.Clini Cardio. 2016; 39: 257-262
- Dapagliflozin and recurrent heart failure hospitalizations in heart failure with reduced ejection fraction: an analysis of DAPA-HF.Circulation. 2021; 143: 1962-1972
- A global measure of perceived stress.J Health Soc Behav. 1983; 24: 385-396
- Effects of depression on heart failure self-care.J Card Fail. 2021; 27: 522-532
- Computationally efficient marginal models for clustered recurrent event data.Biometrics. 2012; 68: 637-647
- Epidemiology of heart failure.Eur J Heart Fail. 2020; 22: 1342-1356
- Glucose-lowering drugs and hospitalization for heart failure: a systematic review and additive-effects network meta-analysis with more than 500 000 patient-years.J Clin Endocrinol Metab. 2021; 106: 3060-3067
- Blood pressure and prognosis in patients with incident heart failure: the Diet, Cancer and Health (DCH) cohort study.Clin Res Cardiol. 2015; 104: 1088-1096
- Home telemonitoring to reduce readmission of high-risk patients: a modified intention-to-treat randomized clinical trial.J Gen Intern Med. 2021; 36: 3395-3401
- Validity of an ecometric neighborhood physical disorder measure constructed by virtual street audit.Am J Epidemiol. 2014; 180: 626-635
Article Info
Publication History
Published online: April 23, 2022
Footnotes
Funding: This study was funded by grant 5R01HL119286 from the National Heart, Lung, and Blood Institute, Bethesda, Maryland.
Conflicts of Interest: None.
Authorship: All authors had access to the data and a role in writing this manuscript.
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
