Carmen C Cuthbertson1, Gerardo Heiss2, Jacqueline D Wright3, Ricky Camplain4, Mehul D Patel5, Randi E Foraker6, Kunihiro Matsushita7, Nicole Puccinelli-Ortega8, Amil M Shah9, Anna M Kucharska-Newton2. 1. Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill. Electronic address: carmenc@email.unc.edu. 2. Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill. 3. Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD. 4. Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ. 5. Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill. 6. School of Medicine, Washington University in St. Louis, St. Louis, MO. 7. Department of Epidemiology, Johns Hopkins University, Baltimore, MD. 8. Wake Forest Baptist Health, Winston-Salem, NC. 9. Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA.
Abstract
PURPOSE: Despite well-documented associations of socioeconomic status with incident heart failure (HF) hospitalization, little information exists on the relationship of socioeconomic status with HF diagnosed in the outpatient (OP) setting. METHODS: We used Poisson models to examine the association of area-level indicators of educational attainment, poverty, living situation, and density of primary care physicians with incident HF diagnosed in the inpatient (IP) and OP settings among a cohort of Medicare beneficiaries (n = 109,756; 2001-2013). RESULTS: The age-standardized rate of HF incidence was 35.8 (95% confidence interval [CI], 35.1-36.5) and 13.9 (95% CI, 13.5-14.4) cases per 1000 person-years in IP and OP settings, respectively. The incidence rate differences (IRDs) per 1000 person-years in both settings suggested greater incidence of HF in high- compared to low-poverty areas (IP IRD = 4.47 [95% CI, 3.29-5.65], OP IRD = 1.41 [95% CI, 0.61-2.22]) and in low- compared to high-education areas (IP IRD = 3.73 [95% CI, 2.63-4.82], OP IRD = 1.72 [95% CI, 0.97-2.47]). CONCLUSIONS: Our results highlight the role of area-level social determinants of health in the incidence of HF in both the IP and OP settings. These findings may have implications for HF prevention policies.
PURPOSE: Despite well-documented associations of socioeconomic status with incident heart failure (HF) hospitalization, little information exists on the relationship of socioeconomic status with HF diagnosed in the outpatient (OP) setting. METHODS: We used Poisson models to examine the association of area-level indicators of educational attainment, poverty, living situation, and density of primary care physicians with incident HF diagnosed in the inpatient (IP) and OP settings among a cohort of Medicare beneficiaries (n = 109,756; 2001-2013). RESULTS: The age-standardized rate of HF incidence was 35.8 (95% confidence interval [CI], 35.1-36.5) and 13.9 (95% CI, 13.5-14.4) cases per 1000 person-years in IP and OP settings, respectively. The incidence rate differences (IRDs) per 1000 person-years in both settings suggested greater incidence of HF in high- compared to low-poverty areas (IP IRD = 4.47 [95% CI, 3.29-5.65], OP IRD = 1.41 [95% CI, 0.61-2.22]) and in low- compared to high-education areas (IP IRD = 3.73 [95% CI, 2.63-4.82], OP IRD = 1.72 [95% CI, 0.97-2.47]). CONCLUSIONS: Our results highlight the role of area-level social determinants of health in the incidence of HF in both the IP and OP settings. These findings may have implications for HF prevention policies.
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