Neighbourhood-level social deprivation and the risk of recurrent heart failure hospitalizations in type 2 diabetes

Background: The importance of type 2 diabetes mellitus (T2D) in heart failure hospitalizations (HFH) is acknowledged. As information on the prevalence and influ-ence of social deprivation on HFH is limited, we studied this issue in a racially diverse cohort.Methods: Linking data from US Veterans with stable T2D (without prevalent HF) with a zip-code derived population-level social deprivation index (SDI), we grouped them according to increasing SDI as follows: SDI: group I: =20; II: 21-40; III: 41-60; IV: 61-80; and V (most deprived) 81-100. Over a 10-year follow-up period, we identi-fied the total (first and recurrent) number of HFH episodes for each patient and calculated the age-adjusted HFH rate [per 1000 patient-years (PY)]. We analysed the incident rate ratio between SDI groups and HFH using adjusted analyses.Results: In 1 012 351 patients with T2D (mean age 67.5 years, 75.7% White), the cumulative incidence of first HFH was 9.4% and 14.2% in SDI groups I and V respec-tively. The 10-year total HFH rate was 54.8 (95% CI: 54.5, 55.2)/1000 PY. Total HFH increased incrementally from SDI group I [43.3 (95% CI: 42.4, 44.2)/1000 PY] to group V [68.6 (95% CI: 67.8, 69.9)/1000 PY]. Compared with group I, group V patients had a 53% higher relative risk of HFH. The negative association between SDI and HFH was stronger in Black patients (SDI x Race pinteraction < .001).Conclusions: Social deprivation is associated with increased HFH in T2D with a dis-proportionate influence in Black patients. Strategies to reduce social disparity and equalize racial differences may help to bridge this gap.

Automated summary

This study analyzed the influence of social deprivation on heart failure hospitalizations in patients with type 2 diabetes mellitus (T2D). The results showed that social deprivation was positively associated with heart failure hospitalization rates, with a greater impact in Black patients. Strategies to reduce social disparity and equalize racial differences may help to bridge this gap.