Association Between Neighborhood Deprivation and Heart Failure Among Patients With Diabetes Mellitus : A 10-Year Follow-Up Study in Sweden

Background: Our aim was to study the potential effect of neighborhood deprivation on incident heart failure (HF) in patients with diabetes mellitus (DM). Methods: The study population included adults (n = 434,542) aged 30 years or older with DM followed from 2005 to 2015 in Sweden for incident HF. The association between neighborhood deprivation and the outcome was explored using Cox regression analysis, with hazard ratios (HRs) and 95% confidence intervals (95% CIs). All models were conducted in both men and women and adjusted for age, educational level, family income, employment status, region of residence, immigrant status, marital status, mobility, and comorbidities. DM patients living in neighborhoods with high or moderate levels of deprivation were compared with those living in neighborhoods with low deprivation scores (reference group). Results: There was an association between level of neighborhood deprivation and HF in DM patients. The HRs were 1.27, 95% CI 1.21–1.33, for men and 1.30, 95% CI 1.23–1.37, for women) among DM patients living in high deprivation neighborhoods compared with those from low deprivation neighborhoods. After adjustments for potential confounders, the higher HRs of HF remained significant: 1.11, 95% CI 1.06–1.16, in men and 1.15, 95% CI 1.09–1.21, in women living in high deprivation neighborhoods. Conclusions: Increased incidence rates of HF among DM patients living in deprived neighborhoods raise important clinical and public health concerns. These findings could serve as an aid to policy-makers when allocating resources in primary health-care settings as well as to clinicians who encounter patients in deprived neighborhoods