The following is the summary of “Relationships between neighborhood disadvantage and cardiovascular findings at autopsy in subjects with sudden death” published in the February 2023 issue of Heart Journal by Cornelissen et al.
Living in a disadvantaged area makes you more likely to die unexpectedly from heart failure. But autopsy results have never been studied in this light before. Here, researchers aimed to investigate links between socioeconomic status and autopsy findings related to the cardiovascular system in unexpected deaths in Maryland.
The street addresses and 9-digit zip codes of 2,278 subjects reported in the CVPath Sudden Death Registry in Maryland were screened. For 1,464 people, 650 of whom identified as Black and 814 ide White, an area deprivation index (ADI) was provided to measure the degree of disadvantage in their local community. Determinants of mortality and cardiac gross and histopathologic findings were the primary endpoints of the investigation. Subjects from the most impoverished areas (i.e., ADI ≥ 8; n=607) died at a younger age (46.0 ±7 14.10 vs. 47.78 1 ± 3.86 years; P=0.02) and were more likely to be Black or female than those from the least disadvantaged neighborhoods (i.e., ADI 7; n=857). Their atherosclerotic plaque characteristics, such as plaque burden, calcification, intraplaque hemorrhage, and thin-cap fibroatheroma, were less severe, and they wer less likely to die from cardiac causes of death (61.8% vs. 67.7%; P=0.02).
Plaque rupture was also less common in people living in the poorest areas (18.8% vs. 25.1%, P=0.004). After controlling for more conventional risk variables, including racial background, however, these correlations disappeared. Moreover, after controlling for cardiovascular risk factors and race, the association between neighborhood deprivation and cause of death or coronary histopathology disappeared, suggesting that other social determinants of health, beyond neighborhood deprivation, play a more important role in sudden cardiac death.