Heart failure & cardiomyopathiesCohort study
Historical Redlining, Socioeconomic Distress, and Risk of Heart Failure Among Medicare Beneficiaries
- Retrospective cohort study
Authors' conclusion
Historical redlining is associated with an increased risk of HF among Black patients. Contemporary zip code-level social determinants of health modify the relationship between redlining and HF risk, with the strongest relationship between redlining and HF observed in the most socioeconomically disadvantaged communities.
Study context
- Population
- White and Black Medicare beneficiaries; zip code-level redlining from the Mapping Inequality ProjectBlack n=801,452
- Participants
- 2,388,955 participants
- Exposure
- Higher zip code redlining proportion vs quartiles 1-3
- Outcome
- HF risk, assessed separately among White and Black beneficiaries
Main finding
As reported in the abstract
HF risk, zip code redlining proportion Q4 vs Q1-3, by race
Quartile 4 vs Quartiles 1-3Risk ratio (95% CI)P value
Black beneficiaries; adjusted for age, sex, comorbidities
1.08(1.04–1.12)
P < 0.001Black beneficiaries; further adjusted for area-level Social Deprivation Index
1.04(1.002–1.08)
P = 0.04- White beneficiaries: redlining associated with lower heart failure (HF) risk (adjusted for age, sex, comorbidities); risk ratio
- 0.94 (0.89-0.99); P=0.02 (95% CI)
- Redlining × Social Deprivation Index interaction: higher redlining associated with HF risk only in socioeconomically distressed regions (above median SDI)
- P for interaction < 0.01
Observational data: associations, not effects.
Further findings
HF risk by Social Deprivation Index (Black beneficiaries)
- Higher redlining proportion significantly associated with HF risk only in socioeconomically distressed regions (above median Social Deprivation Index)
- interaction P (Pinteraction<0.01)
Original publication
Historical Redlining, Socioeconomic Distress, and Risk of Heart Failure Among Medicare Beneficiaries. Circulation. Published 17 July 2023. doi:10.1161/circulationaha.123.064351
Summarised from the published abstract; every number is checked against it