Miguel Cainzos-Achirica1, Cristina Capdevila2, Emili Vela3, Montse Cleries3, Usama Bilal4, Ana Garcia-Altes5, Cristina Enjuanes6, Alberto Garay6, Sergi Yun7, Nuria Farre8, Xavier Corbella9, Josep Comin-Colet10. 1. Community Heart Failure Program, Department of Cardiology, Bellvitge University Hospital and Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Department of Cardiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA; RTI Health Solutions, Pharmacoepidemiology and Risk Management, Barcelona, Spain. 2. Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Universitat de Barcelona, Barcelona, Spain. 3. Healthcare Information and Knowledge Unit, Catalan Health Service, Barcelona, Spain. 4. Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, USA; Social and Cardiovascular Epidemiology Research Group, School of Medicine, University of Alcala, Alcala de Henares, Madrid, Spain. 5. Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain. 6. Community Heart Failure Program, Department of Cardiology, Bellvitge University Hospital and Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain. 7. Community Heart Failure Program, Department of Cardiology, Bellvitge University Hospital and Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Department of Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain. 8. Heart Failure Unit, Department of Cardiology, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain; Heart Diseases Biomedical Research Group (GREC), Hospital del Mar Biomedical Research Institute (IMIM), Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain. 9. Department of Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Hestia Chair in Integrated Health and Social Care, School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain. 10. Community Heart Failure Program, Department of Cardiology, Bellvitge University Hospital and Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Universitat de Barcelona, Barcelona, Spain. Electronic address: jcomin@bellvitgehospital.cat.
Abstract
BACKGROUND: To evaluate the associations between individual income, all-cause mortality and use of healthcare resources in a very large population of chronic heart failure (CHF) patients living in Catalonia (Spain), where access to public healthcare is granted by law. METHODS AND RESULTS: We used 2016 data from the Catalan Health Surveillance System, a large, exhaustive, administrative healthcare database which includes information on medical diagnoses, healthcare resource use, and individual income for all Catalan residents (N = 7,638,524). Individual annual income was categorized as high (>100,000€), medium (18,000-100,000€), low (<18,000€), and very low (welfare support). Among 155,883 CHF patients, lower individual income was associated with a shorter life expectancy at age 50 (life expectancy for high income patients 22.2 years, for very low income patients 12.8), and were independently associated with higher all-cause mortality adjusting for age, sex, comorbidities, and duration of the CHF diagnosis (odds ratio very low vs. medium income 1.21 [95% CI 1.11, 1.33]). Also, in patients with lower income levels the burden of public healthcare resource use was displaced towards urgent hospitalizations and frequent emergency department visits, as opposed to regular, specialized CHF ambulatory-based care. CONCLUSION: In a very large population of CHF patients with access to universal healthcare, lower income was independently associated with higher mortality and with lower use of ambulatory-based healthcare resources. Our findings suggest that CHF patients may benefit from systematic assessment of their socioeconomic status, as this may aid the identification of vulnerable subgroups who may benefit from tailored health education and management.
BACKGROUND: To evaluate the associations between individual income, all-cause mortality and use of healthcare resources in a very large population of chronic heart failure (CHF) patients living in Catalonia (Spain), where access to public healthcare is granted by law. METHODS AND RESULTS: We used 2016 data from the Catalan Health Surveillance System, a large, exhaustive, administrative healthcare database which includes information on medical diagnoses, healthcare resource use, and individual income for all Catalan residents (N = 7,638,524). Individual annual income was categorized as high (>100,000€), medium (18,000-100,000€), low (<18,000€), and very low (welfare support). Among 155,883 CHFpatients, lower individual income was associated with a shorter life expectancy at age 50 (life expectancy for high income patients 22.2 years, for very low income patients 12.8), and were independently associated with higher all-cause mortality adjusting for age, sex, comorbidities, and duration of the CHF diagnosis (odds ratio very low vs. medium income 1.21 [95% CI 1.11, 1.33]). Also, in patients with lower income levels the burden of public healthcare resource use was displaced towards urgent hospitalizations and frequent emergency department visits, as opposed to regular, specialized CHF ambulatory-based care. CONCLUSION: In a very large population of CHFpatients with access to universal healthcare, lower income was independently associated with higher mortality and with lower use of ambulatory-based healthcare resources. Our findings suggest that CHFpatients may benefit from systematic assessment of their socioeconomic status, as this may aid the identification of vulnerable subgroups who may benefit from tailored health education and management.
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