Elsevier

JACC: Heart Failure

Volume 8, Issue 11, November 2020, Pages 917-927
JACC: Heart Failure

Clinical Research
Socioeconomic Gradients in Mortality Following HF Hospitalization in a Country With Universal Health Care Coverage

https://doi.org/10.1016/j.jchf.2020.05.015Get rights and content
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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.

Key Words

education
epidemiology
heart failure
income
mortality

Abbreviations and Acronyms

AF
atrial fibrillation
CI
confidence interval
EF
ejection fraction
HF
heart failure
HR
hazard ratio
NOK
Norwegian Kroner
SEP
socioeconomic position

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The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Heart Failure author instructions page.