Inge Schjødt1, Søren P Johnsen2, Anna Strömberg3, Nickolaj R Kristensen4, Brian B Løgstrup5. 1. Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. Electronic address: ingeschjdt@rm.dk. 2. Department of Clinical Medicine, Danish Center for Clinical Health Services Research, Aalborg University, Aalborg, Denmark. 3. Department of Medical and Health Sciences, and Department of Cardiology, Linköping University, Linköping, Sweden. 4. Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark. 5. Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
Abstract
OBJECTIVES: This study examined the associations between socioeconomic factors (SEF), readmission, and mortality in patients with incident heart failure (HF) with reduced ejection fraction (HFrEF) in a tax-financed universal health care system. BACKGROUND: Lack of health insurance is considered a key factor in health inequality, leading to poor clinical outcomes. However, data are sparse for the association between SEF and clinical outcomes among patients with HF in countries with tax-financed health care systems. METHODS: A nationwide population-based cohort study of 17,122 patients with incident HFrEF was carried out. Associations were assessed between individual-level SEF (cohabitation status, education, and income) and all-cause, HF, and non-HF readmission and mortality within 1 to 30, 31 to 90, and 91 to 365 days, as well as hospital bed days within 1 year after HF diagnosis. RESULTS: Low income was associated with a higher risk of all-cause readmission (adjusted hazard ratio [HR]: 1.24; 95% confidence interval [CI]: 1.08 to 1.43) and non-HF readmission (HR: 1.36; 95% CI: 1.17 to 1.58) within days 31 to 90 as well as with a higher risk of all-cause (HR: 1.27; 95% CI: 1.14 to 1.41), HF (HR: 1.26; 95% CI: 1.02 to 1.55) and non-HF readmission (HR: 1.25; 95% CI: 1.12 to 1.39) within days 91 to 365. Low-income patients also had a higher use of hospital bed days and risk of mortality during follow-up. CONCLUSIONS: In a tax-financed universal health care system, low income was associated with a higher risk of all-cause and non-HF readmission within 1 to 12 months after HF diagnosis and with HF readmission within 3 to 12 months among patients with incident HFrEF. Low-income patients also had a higher number of hospital bed days and a higher rate of mortality during follow-up.
OBJECTIVES: This study examined the associations between socioeconomic factors (SEF), readmission, and mortality in patients with incident heart failure (HF) with reduced ejection fraction (HFrEF) in a tax-financed universal health care system. BACKGROUND: Lack of health insurance is considered a key factor in health inequality, leading to poor clinical outcomes. However, data are sparse for the association between SEF and clinical outcomes among patients with HF in countries with tax-financed health care systems. METHODS: A nationwide population-based cohort study of 17,122 patients with incident HFrEF was carried out. Associations were assessed between individual-level SEF (cohabitation status, education, and income) and all-cause, HF, and non-HF readmission and mortality within 1 to 30, 31 to 90, and 91 to 365 days, as well as hospital bed days within 1 year after HF diagnosis. RESULTS: Low income was associated with a higher risk of all-cause readmission (adjusted hazard ratio [HR]: 1.24; 95% confidence interval [CI]: 1.08 to 1.43) and non-HF readmission (HR: 1.36; 95% CI: 1.17 to 1.58) within days 31 to 90 as well as with a higher risk of all-cause (HR: 1.27; 95% CI: 1.14 to 1.41), HF (HR: 1.26; 95% CI: 1.02 to 1.55) and non-HF readmission (HR: 1.25; 95% CI: 1.12 to 1.39) within days 91 to 365. Low-income patients also had a higher use of hospital bed days and risk of mortality during follow-up. CONCLUSIONS: In a tax-financed universal health care system, low income was associated with a higher risk of all-cause and non-HF readmission within 1 to 12 months after HF diagnosis and with HF readmission within 3 to 12 months among patients with incident HFrEF. Low-income patients also had a higher number of hospital bed days and a higher rate of mortality during follow-up.
Authors: Anna Ohlsson; Nils Eckerdal; Bertil Lindahl; Marianne Hanning; Ragnar Westerling Journal: BMC Public Health Date: 2021-06-02 Impact factor: 3.295