Abstract
BACKGROUND: Heart failure (HF) is a major contributor to hospitalizations and mortality in the United States, with significant racial disparities in care access and clinical outcomes. Social determinants of health (SDoH) play a critical role in shaping these disparities. OBJECTIVES: This study aimed to assess the impact of neighborhood deprivation on racial disparities in HF outcomes and quantify the changes in adverse outcomes if non-Hispanic Black (NHB) patients resided in neighborhoods with SDoH level equal to those of non-Hispanic White (NHW) patients. METHODS: We conducted a retrospective cohort study using electronic health records from the University of Florida, including adults hospitalized for HF between 2016 and 2021. SDoH level was measured using the Area Deprivation Index (ADI). The primary outcome was a composite measure of 1-year readmission and all-cause mortality. A counterfactual framework was applied to estimate how NHB patient outcomes might change if they lived in neighborhoods with ADI distributions equivalent to NHW patients. RESULTS: Among 42,279 patients (mean age 65 ± 14.3 years; 48% women), NHB patients had more 1-year composite outcomes (32.92%) compared to NHW patients (27.69%). Adjusted analyses showed NHB patients had a higher risk of readmission or mortality (aOR: 1.101; 95% CI: 1.063-1.139). Counterfactual modeling showed that if NHB patients resided in neighborhoods with ADI distributions same as NHW patients, their outcome rate would decrease by 1.31% (95% CI: 1.309%-1.311%). CONCLUSIONS: This study highlights racial disparities in HF outcomes attributed to neighborhood deprivation. Improving socioeconomic conditions in deprived neighborhoods could mitigate disparities in HF.