This dissertation explores the relationship between socioeconomic status and the progression of heart failure following an incident heart failure hospitalization, defined in three domains: rehospitalization, mortality and self-rated health. Hospital admissions for heart failure are on the rise in the United States, and mortality remains high among heart failure patients. Meanwhile, self-rated health is a potent predictor of future health, and its trajectory among heart failure patients is unknown. The first aim was to estimate the effect of neighborhood socioeconomic and Medicaid status on the time to first rehospitalization and the rehospitalization rate. Participants who lived in low neighborhood socioeconomic areas at baseline who had multiple comorbidities during the incident heart failure hospitalization were rehospitalized faster and more often compared to participants living in high socioeconomic neighborhoods at baseline with multiple comorbidities. Meanwhile, Medicaid recipients with a low level of comorbidity were rehospitalized faster and more often compared to non-Medicaid recipients. The second aim was to estimate the effect of neighborhood socioeconomic and Medicaid status on the time to and risk of mortality. Participants who lived in low neighborhood socioeconomic areas at baseline who had multiple comorbidities during the index heartfailure hospitalization experienced a shorter time to death compared to participants living in high socioeconomic neighborhoods at baseline with multiple comorbidities. A comparison of the trajectory of self-rated health across time was examined among participants as part of the third aim. Predictors of a decline in self-rated health across time were assessed, and factors shown to contribute to poorer self-rated health regardless of incident disease status included advanced age, low educational attainment, current smoking and obesity. This dissertation brings to attention several areas for future research in cardiovascular disease epidemiology. The first is a need to better understand the relationship of socioeconomic status and the progression of heart failure in terms of its out-of-hospital management. The second is to explore the mechanisms underlying the relationship between poor socioeconomic status and increased mortality. Lastly, interventions can be tested to help understand how to improve self-rated health, and the resulting health outcomes, among aging adults
