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Socioeconomic Factors and Clinical Outcomes Among Patients With Heart Failure in a Universal Health Care System
Aarhus Univ Hosp, Denmark.
Aalborg Univ, Denmark.
Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.ORCID iD: 0000-0002-4259-3671
Aarhus Univ Hosp, Denmark.
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2019 (English)In: JACC. Heart failure, ISSN 2213-1779, E-ISSN 2213-1787, Vol. 7, no 9, p. 746-755Article in journal (Refereed) Published
Abstract [en]

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. (C) 2019 by the American College of Cardiology Foundation.

Place, publisher, year, edition, pages
ELSEVIER SCI LTD , 2019. Vol. 7, no 9, p. 746-755
Keywords [en]
heart failure; mortality; patient readmission; socioeconomic factor; universal health care system
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General Practice
Identifiers
URN: urn:nbn:se:liu:diva-160405DOI: 10.1016/j.jchf.2019.06.003ISI: 000483353000002PubMedID: 31466671OAI: oai:DiVA.org:liu-160405DiVA, id: diva2:1353545
Note

Funding Agencies|Program for Clinical Research Infrastructure; Novo Nordisk Foundation [R3-038]; Danish Nurses Organization Research Foundation

Available from: 2019-09-23 Created: 2019-09-23 Last updated: 2019-09-23

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Strömberg, Anna
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Division of Nursing ScienceFaculty of Medicine and Health SciencesDepartment of Cardiology in Linköping
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