Gerhard Sulo1, Jannicke Igland2, Simon Øverland3, Enxhela Sulo4, Jonas Minet Kinge5, Gregory A Roth6, Grethe S Tell7. 1. Centre for Disease Burden, Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway; Oral Health Centre of Expertise in Western Norway-Hordaland, Bergen, Norway. Electronic address: Gerhard.Sulo@fhi.no. 2. Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway. 3. Centre for Disease Burden, Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway; Department of Psychosocial Science, University of Bergen, Bergen, Norway. 4. Haraldsplass Diakonale Sykehus, Bergen, Norway. 5. Centre for Disease Burden, Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway; Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway; Department of Health Management and Health Economics, University of Oslo, Oslo, Norway. 6. Institute for Health Metrics and Evaluation (IHME), University of Washington, Seattle, Washington. 7. Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway.
Abstract
OBJECTIVES: This study explored the association between socioeconomic position (SEP) and long-term mortality following first heart failure (HF) hospitalization. BACKGROUND: It is not clear to what extent education and income-individually or combined-influence mortality among patients with HF. METHODS: This study included 49,895 patients, age 35+ years, with a first HF hospitalization in Norway during 2000 to 2014 and followed them until death or December 31, 2014. The association between education, income, and mortality was explored using Cox regression models, stratified by sex and age group (35 to 69 years and 70+ years). RESULTS: Compared with patients with primary education, those with tertiary education had lower mortality (adjusted hazard ratio [HR]: 0.89; 95% confidence interval [CI]: 0.78 to 0.99 in younger men; HR: 0.57; 95% CI: 0.43 to 0.75 in younger women; HR: 0.90; 95% CI: 0.84 to 0.97 in older men, and HR: 0.87; 95% CI: 0.81 to 0.93 in older women). After adjusting for educational differences, younger and older men and younger women in the highest income quintile had lower mortality compared with those in the lowest income quintile (HR: 0.63; 95% CI: 0.55 to 0.72; HR: 0.78; 95% CI: 0.63 to 0.96, and HR: 0.91; 95% CI: 0.86 to 0.97, respectively). The association between income and mortality was almost linear. No association between income and mortality was observed in older women. CONCLUSIONS: Despite the well-organized universal health care system in Norway, education and income were independently associated with mortality in patients with HF in a clear sex- and age group-specific pattern.
OBJECTIVES: This study explored the association between socioeconomic position (SEP) and long-term mortality following first heart failure (HF) hospitalization. BACKGROUND: It is not clear to what extent education and income-individually or combined-influence mortality among patients with HF. METHODS: This study included 49,895 patients, age 35+ years, with a first HF hospitalization in Norway during 2000 to 2014 and followed them until death or December 31, 2014. The association between education, income, and mortality was explored using Cox regression models, stratified by sex and age group (35 to 69 years and 70+ years). RESULTS: Compared with patients with primary education, those with tertiary education had lower mortality (adjusted hazard ratio [HR]: 0.89; 95% confidence interval [CI]: 0.78 to 0.99 in younger men; HR: 0.57; 95% CI: 0.43 to 0.75 in younger women; HR: 0.90; 95% CI: 0.84 to 0.97 in older men, and HR: 0.87; 95% CI: 0.81 to 0.93 in older women). After adjusting for educational differences, younger and older men and younger women in the highest income quintile had lower mortality compared with those in the lowest income quintile (HR: 0.63; 95% CI: 0.55 to 0.72; HR: 0.78; 95% CI: 0.63 to 0.96, and HR: 0.91; 95% CI: 0.86 to 0.97, respectively). The association between income and mortality was almost linear. No association between income and mortality was observed in older women. CONCLUSIONS: Despite the well-organized universal health care system in Norway, education and income were independently associated with mortality in patients with HF in a clear sex- and age group-specific pattern.