Area-Level SDOH Linked to Worse Cardiovascular Outcomes in Hypertrophic Cardiomyopathy

Area-based social determinants of health (SDOH), including neighborhood income and social deprivation, were independently associated with worse cardiovascular outcomes among adults with hypertrophic cardiomyopathy (HCM), according to findings from a large multicenter cohort study.¹

Despite HCM’s strong genetic basis, patients residing in lower-income or more socially deprived areas faced significantly higher risks of heart failure, ventricular and atrial arrhythmias, stroke, and death, highlighting that where patients live may meaningfully influence disease trajectory and long-term outcomes.

This multicenter cohort study is published in JAMA Cardiology.

“The present study extends these associations to include patients from multiple institutions across the US, incorporates genotype status, provides granular clinical outcomes data from a prospective registry with longitudinal follow-up, and includes a broader composite metric of area-based socioeconomic status,” wrote the researchers of the study.

HCM is a genetic heart condition in which the heart muscle, particularly the wall dividing the lower chambers, becomes abnormally thickened, reducing the heart’s ability to pump blood effectively and sometimes obstructing blood flow out of the left ventricle.² It affects about 1 in 500 individuals in the US and can range from asymptomatic to causing symptoms such as chest pain, shortness of breath, palpitations, and fainting.

In this multicenter, prospective cohort study, investigators analyzed data from adult patients with hypertrophic cardiomyopathy enrolled at 5 US sites participating in the Sarcomeric Human Cardiomyopathy Registry.¹ Patients were followed for a median (IQR) of 2.15 (0.15-5.82) years, with data collected between 2015 and March 2024 and analyzed through June 2025. Residential addresses at the time of enrollment were geocoded at the zip code level and linked to the American Community Survey to derive area-based measures of social determinants of health, including median household income and the Social Deprivation Index (SDI). Additionally, the researchers evaluated associations between these area-level SDOH measures and cardiovascular outcomes, adjusting for age at diagnosis, sex, body mass index, and hypertension.

Among 4431 US adults with hypertrophic cardiomyopathy, the median age at diagnosis was 51.3 (IQR, 38.9-61.6) years, and 1862 patients (42.0%) were female. The median area-based household income was $80,000 (IQR, $60,000-$110,000), and the median SDI score was 25 (IQR, 10-55). After multivariable adjustment, patients living in the lowest-income areas had more than twice the risk of heart failure compared with those in the highest-income areas (adjusted hazard ratio [aHR], 2.07; 95% CI, 1.77-2.42; P < .001) and a significantly higher risk of the composite outcome of ventricular arrhythmias, heart failure, atrial fibrillation, stroke, and death (aHR, 1.52; 95% CI, 1.36-1.69; P < .001).

Ventricular arrhythmia risk was numerically higher but did not reach statistical significance (aHR, 1.31; 95% CI, 0.97-1.78; P = .08). Similarly, residence in the most socially deprived areas was associated with increased risks of heart failure (aHR, 1.48; 95% CI, 1.29-1.70; P < .001), ventricular arrhythmias (aHR, 1.55; 95% CI, 1.15-2.09; P = .004), and the overall composite outcome (aHR, 1.36; 95% CI, 1.22-1.50; P < .001) compared with the least deprived areas.

However, the researchers noted some limitations, which include using zip code–level SDOH, which may miss neighborhood and individual differences, and including only US adults. Additionally, the data reflected a single time point and may not capture changes over time. Lastly, adjustment for clinical risk factors may have underestimated the true impact of social determinants on HCM outcomes.

Despite these limitations, the researchers believe these findings highlight that even in a genetically driven condition like HCM, where biology plays a central role, social and environmental factors can meaningfully influence disease trajectory. Incorporating area-based SDOH into risk assessment may help identify high-risk patients, inform targeted interventions, and ultimately reduce disparities in HCM outcomes.

“In conclusion, per the results of this cohort study, there was a significant association between residing in an area with lower household income or higher SDI and adverse outcomes in patients with HCM,” wrote the researchers. “This analysis demonstrates that where someone lives may influence clinical outcomes, even in conditions with strong genetic etiologies like HCM, and one’s environment likely contributes to the heterogeneity of disease presentation.”

References

1. Hafeez N, Claggett BL, Owens AT, et al. Social determinants of health and clinical outcomes in hypertrophic cardiomyopathy. JAMA Cardiol. Published online January 07, 2026. doi:10.1001/jamacardio.2025.4869

2. Hypertrophic cardiomyopathy. Cleveland Clinic. Updated June 4, 2025. Accessed January 15, 2026. https://my.clevelandclinic.org/health/diseases/17116-hypertrophic-cardiomyopathy