Socioeconomic Gradients in Mortality Following HF Hospitalization in a Country With Universal Health Care Coverage,JACC: Heart Failure

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Socioeconomic Gradients in Mortality Following HF Hospitalization in a Country With Universal Health Care Coverage
JACC: Heart Failure ( IF 10.3 ) Pub Date : 2020-10-07 , DOI: 10.1016/j.jchf.2020.05.015
Gerhard Sulo ₁ , Jannicke Igland ₂ , Simon Øverland ₃ , Enxhela Sulo ₄ , Jonas Minet Kinge ₅ , Gregory A Roth ₆ , Grethe S Tell ₇

Affiliation

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.

中文翻译：

在拥有全民医疗保险的国家中，因心力衰竭住院后死亡率的社会经济梯度

目标

这项研究探讨了首次住院后出现心力衰竭（HF）后的社会经济地位（SEP）与长期死亡率之间的关系。

背景

目前尚不清楚教育和收入（个人或综合）在多大程度上影响HF患者的死亡率。

方法

该研究纳入了49895名年龄在35岁以上的患者，2000年至2014年在挪威首次进行了HF住院治疗，之后一直随访至死亡或2014年12月31日。采用Cox回归模型对教育，收入和死亡率之间的关联进行了分层研究按性别和年龄段划分（35至69岁和70岁以上）。

结果

与接受初等教育的患者相比，接受高等教育的患者的死亡率较低（年轻男性的调整后危险比[HR]：0.89； 95％置信区间[CI]：0.78至0.99； HR：0.57； 95％CI：0.43至0.75 （HR）：0.90； HR：0.90； 95％CI：0.84至0.97； HR：0.87； 95％CI：0.81至0.93）。在对教育差异进行调整后，收入最低的五分之一的年轻人和较年轻的男女死亡率要低于收入最低的五分之一的男女（HR：0.63； 95％CI：0.55至0.72； HR：0.78； 95％CI：分别为0.63至0.96和HR：0.91； 95％CI：0.86至0.97）。收入和死亡率之间的关系几乎是线性的。在老年妇女中，收入与死亡率之间没有关联。