Abstract P153: Multiple Vulnerabilities to Health Disparities and Incident Heart Failure in the Reasons for Geographic and Racial Differences in Stroke Study
Abstract P153: Multiple Vulnerabilities to Health Disparities and Incident Heart Failure in the Reasons for Geographic and Racial Differences in Stroke Study
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摘要 P153：中风研究中地理和种族差异的原因导致健康差异和心力衰竭事件的多重脆弱性
作者：
L. Pinheiro;E. Reshetnyak;M. Sterling;E. Levitan;M. Safford;P. Goyal
背景：
健康差异的多个社会决定脆弱性（SDV）通常集中在同一个人身上。先前的研究表明，SDV 与心力衰竭 (HF) 风险增加单独相关。由于这些 SDV 在同一个体中可能会产生累积效应，因此了解它们对心力衰竭发病率的共同影响至关重要。
方法：
REGARDS 是一项全国前瞻性队列研究，从 2003 年到 2007 年招募了 30,239 名 45 岁以下的成年人，并持续进行随访。我们对 2016 年 12 月 31 日之前没有发生心力衰竭住院的基线参与者进行了跟踪。在健康人 2020 框架的指导下，我们检查了 10 种潜在的 SDV，保留了与心力衰竭事件相关的那些 (p<0.10)，并创建了 SDV 计数 (0、1、2、3+)。我们使用 Cox 模型来检查 SDV 计数与心力衰竭事件之间的关联，并针对潜在的混杂因素进行调整。由于心力衰竭的差异在年轻人中最为明显，因此模型按年龄进行分层。
结果：
对 25,790 名参与者进行了平均 10.1 年的随访（IQR 6.5、11.9）；他们的基线平均年龄为 64.8 岁，其中 55% 为女性，40% 为黑人。在年龄调整模型中，黑人种族、教育程度低、家庭年收入低、邮政编码贫困、公共卫生基础设施差和缺乏健康保险与心力衰竭事件显着相关。在完全调整的模型中，在 45-64 岁的人群中，与没有 SDV 相比，有 SDV 与心力衰竭事件显着相关，并且计数越高，风险越大（图 1）。其他年龄组没有关联。
结论：
即使在调整心血管危险因素后，SDV 数量的增加与 65 岁以下成人中发生心力衰竭住院的风险相关。使用可在临床评估期间纳入社会史的 SDV 简单计数可以识别出心力衰竭风险增加的年轻人。
Background:
Multiple socially determined vulnerabilities (SDV) to health disparities often cluster within the same individual. Previous studies have shown that SDV are separately associated with increased risk of heart failure (HF). As there may be a cumulative effect of these SDVs in the same individual, understanding their joint impact on the incidence of HF is critical.
Methods:
REGARDS is a national prospective cohort study that recruited 30,239 adults <45 years of age from 2003-2007 with ongoing follow-up. We followed participants free of HF at baseline for incident HF hospitalization through December 31, 2016. Guided by the Healthy People 2020 framework, we examined 10 potential SDVs, retaining those that were associated with incident HF (p<0.10) and creating a count of SDV (0, 1, 2, 3+). We used Cox models to examine associations between the SDV count and incident HF, adjusting for potential confounders. Since disparities in HF have been shown to be greatest in younger individuals models were stratified by age.
Results:
The 25,790 participants were followed for a median of 10.1 years (IQR 6.5, 11.9); their mean age at baseline was 64.8, 55%% were women, and 40% were blacks. In age-adjusted models, Black race, low educational attainment, low annual household income, zip code poverty, poor public health infrastructure, and lack of health insurance were significantly associated with incident HF. In fully adjusted models, among those 45-64 years, compared to having no SDV, having a SDV was significantly associated with incident HF, with a trend toward a higher count conferring greater risk (Fig. 1). There was no association in other age groups.
Conclusions:
An increased number of SDVs was associated with risk of incident HF hospitalization among adults <65 years, even after adjustment for cardiovascular risk factors. Using a simple count of SDVs that could be incorporated into the social history during clinical assessment may identify younger individuals at increased risk of incident HF.