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.

中文翻译：

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全民医疗保健系统中心力衰竭患者的社会经济因素和临床结果。

目标

这项研究检查了在税收资助的全民医疗保健系统中射血分数降低（HFrEF）的突发性心力衰竭（HF）患者的社会经济因素（SEF），再入院率和死亡率之间的关联。

背景

缺乏健康保险被认为是造成健康不平等的关键因素，从而导致不良的临床结果。但是，在有税收资助的卫生保健系统的国家中，HF患者的SEF与临床结局之间的关联性数据很少。

方法

在全国范围内对17,122例HFrEF事件进行了队列研究。在个人级别的SEF（同居状态，教育和收入）与全因，HF和非HF再入院率和死亡率之间的关联性进行了评估，范围为1至30天，31至90天和91至365天，以及医院HF诊断后一年内的卧床天数。

结果

低收入与全因再入院的风险较高（调整后的危险比[HR]：1.24； 95％置信区间[CI]：1.08至1.43）和非HF再入院（HR：1.36； 95％CI：1.17）在31至90天之内达到1.58），并且全因风险较高（HR：1.27； 95％CI：1.14至1.41），HF（HR：1.26； 95％CI：1.02至1.55）和非HF在91至365天内再次入院（HR：1.25； 95％CI：1.12至1.39）。低收入患者的病床使用天数也较高，且在随访期间有死亡风险。

结论

在税收资助的全民医疗保健系统中，低收入与HF诊断后1至12个月内全因和非HF再入院的风险较高以及HFrEF事件患者在3至12个月内再次入院有关。低收入患者在随访期间的病床天数也更高，死亡率更高。