Kelly D Getz1, Jennifer Lewey2, Vicky Tam3, Olga Corazon Irizarry4, Lisa D Levine4, Richard Aplenc5, Zolt Arany6. 1. Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Center for Pediatric Clinical Effectiveness, Children's Hospital of Pennsylvania, Philadelphia, PA. 2. Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. 3. Data Science and Biostatistics Unit, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA. 4. Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. 5. Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Center for Pediatric Clinical Effectiveness, Children's Hospital of Pennsylvania, Philadelphia, PA; Department of Pediatrics, Division of Oncology, Children's Hospital of Pennsylvania, Philadelphia, PA. 6. Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. Electronic address: zarany@pennmedicine.upenn.edu.
Abstract
BACKGROUND: Peripartum cardiomyopathy (PPCM) disproportionately affects women of African ancestry. Additionally, clinical outcomes are worse in this subpopulation compared to White women with PPCM. The extent to which socioeconomic parameters contribute to these racial disparities is not known. METHODS: We aimed to quantify the association between area-based proxies of socioeconomic status (SES) and clinical outcomes in PPCM, and to determine the potential contribution of these factors to racial disparities in outcomes. A retrospective cohort study was performed at the University of Pennsylvania Health System, a tertiary referral center serving a population with a high proportion of Black individuals. The cohort included 220 women with PPCM, 55% of whom were Black or African American. Available data included clinical and demographic characteristics as well as residential address georeferenced to US Census-derived block group measures of SES. Rates of sustained cardiac dysfunction (defined as persistent LVEF <50%, LVAD placement, transplant, or death) were compared by race and block group-level measures of SES, and a composite neighborhood concentrated disadvantage index (NDI). The contributions of area-based socioeconomic parameters to the association between race and sustained cardiac dysfunction were quantified. RESULTS: Black race and higher NDI were both independently associated with sustained cardiac dysfunction (relative risk [RR] 1.63, confidence interval [CI] 1.13-2.36; and RR 1.29, CI 1.08-1.53, respectively). Following multivariable adjustment, effect size for NDI remained statistically significant, but effect size for Black race did not. The impact of low neighborhood education on racial disparities in outcomes was stronger than that of low neighborhood income (explaining 45% and 0% of the association with black race, respectively). After multivariate adjustment, only low area-based education persisted as significantly correlating with sustained cardiac dysfunction (RR 1.49; CI 1.02-2.17). CONCLUSIONS: Both Black race and NDI independently associate with adverse outcomes in women with PPCM in a single center study. Of the specific components of NDI, neighborhood low education was most strongly associated with clinical outcome and partially explained differences in race. These results suggest interventions targeting social determinants of health in disadvantaged communities may help to mitigate outcome disparities.
BACKGROUND: Peripartum cardiomyopathy (PPCM) disproportionately affects women of African ancestry. Additionally, clinical outcomes are worse in this subpopulation compared to White women with PPCM. The extent to which socioeconomic parameters contribute to these racial disparities is not known. METHODS: We aimed to quantify the association between area-based proxies of socioeconomic status (SES) and clinical outcomes in PPCM, and to determine the potential contribution of these factors to racial disparities in outcomes. A retrospective cohort study was performed at the University of Pennsylvania Health System, a tertiary referral center serving a population with a high proportion of Black individuals. The cohort included 220 women with PPCM, 55% of whom were Black or African American. Available data included clinical and demographic characteristics as well as residential address georeferenced to US Census-derived block group measures of SES. Rates of sustained cardiac dysfunction (defined as persistent LVEF <50%, LVAD placement, transplant, or death) were compared by race and block group-level measures of SES, and a composite neighborhood concentrated disadvantage index (NDI). The contributions of area-based socioeconomic parameters to the association between race and sustained cardiac dysfunction were quantified. RESULTS: Black race and higher NDI were both independently associated with sustained cardiac dysfunction (relative risk [RR] 1.63, confidence interval [CI] 1.13-2.36; and RR 1.29, CI 1.08-1.53, respectively). Following multivariable adjustment, effect size for NDI remained statistically significant, but effect size for Black race did not. The impact of low neighborhood education on racial disparities in outcomes was stronger than that of low neighborhood income (explaining 45% and 0% of the association with black race, respectively). After multivariate adjustment, only low area-based education persisted as significantly correlating with sustained cardiac dysfunction (RR 1.49; CI 1.02-2.17). CONCLUSIONS: Both Black race and NDI independently associate with adverse outcomes in women with PPCM in a single center study. Of the specific components of NDI, neighborhood low education was most strongly associated with clinical outcome and partially explained differences in race. These results suggest interventions targeting social determinants of health in disadvantaged communities may help to mitigate outcome disparities.
Authors: Elvis A Akwo; Edmond K Kabagambe; Frank E Harrell; William J Blot; Justin M Bachmann; Thomas J Wang; Deepak K Gupta; Loren Lipworth Journal: Circ Cardiovasc Qual Outcomes Date: 2018-01
Authors: Somjot S Brar; Steven S Khan; Gagandeep K Sandhu; Michael B Jorgensen; Neil Parikh; Jin-Wen Y Hsu; Albert Yuh-Jer Shen Journal: Am J Cardiol Date: 2007-06-06 Impact factor: 2.778
Authors: Elizabeth J Brown; Daniel Polsky; Corentin M Barbu; Jane W Seymour; David Grande Journal: Health Aff (Millwood) Date: 2016-08-01 Impact factor: 6.301
Authors: Randi E Foraker; Kathryn M Rose; Chirayath M Suchindran; Patricia P Chang; Ann M McNeill; Wayne D Rosamond Journal: Circ Heart Fail Date: 2011-03-23 Impact factor: 8.790
Authors: Mercedes R Carnethon; Jia Pu; George Howard; Michelle A Albert; Cheryl A M Anderson; Alain G Bertoni; Mahasin S Mujahid; Latha Palaniappan; Herman A Taylor; Monte Willis; Clyde W Yancy Journal: Circulation Date: 2017-10-23 Impact factor: 29.690
Authors: Vera Regitz-Zagrosek; Jolien W Roos-Hesselink; Johann Bauersachs; Carina Blomström-Lundqvist; Renata Cífková; Michele De Bonis; Bernard Iung; Mark Richard Johnson; Ulrich Kintscher; Peter Kranke; Irene Marthe Lang; Joao Morais; Petronella G Pieper; Patrizia Presbitero; Susanna Price; Giuseppe M C Rosano; Ute Seeland; Tommaso Simoncini; Lorna Swan; Carole A Warnes Journal: Eur Heart J Date: 2018-09-07 Impact factor: 29.983
Authors: Martijn F Hoes; Zoltan Arany; Johann Bauersachs; Denise Hilfiker-Kleiner; Mark C Petrie; Karen Sliwa; Peter van der Meer Journal: Nat Rev Cardiol Date: 2022-01-11 Impact factor: 49.421
Authors: Amy Li; K Campbell; S Lal; Y Ge; A Keogh; P S Macdonald; P Lau; John Lai; W A Linke; J Van der Velden; A Field; B Martinac; M Grosser; Cristobal Dos Remedios Journal: Biophys Rev Date: 2022-01-24
Authors: S Michaela Rikard; Bommae Kim; Jonathan D Michel; Shayn M Peirce; Laura E Barnes; Michael D Williams Journal: SSM Popul Health Date: 2022-08-30