Influence of Neighborhood Conditions on Recurrent Hospital Readmissions in Patients with Heart Failure: A Cohort Study

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 (& GE;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. (C) 2022 Elsevier Inc. All rights reserved.

Automated summary

The study found that high poverty areas are associated with an increased risk of readmission for patients with heart failure, while built environment and perceived neighborhood conditions are not related to the risk of readmission. The high rates of diabetes and hypertension in these areas partly explain the impact of high poverty rates on readmission risk.