Author + information
- Received May 2, 2019
- Revision received June 4, 2019
- Accepted June 4, 2019
- Published online August 26, 2019.
- Inge Schjødt, RN, MSca,∗ (, )
- Søren P. Johnsen, MD, PhDb,
- Anna Strömberg, RN, PhDc,
- Nickolaj R. Kristensen, MScd and
- Brian B. Løgstrup, MD, PhD, DMSca,e
- aDepartment of Cardiology, Aarhus University Hospital, Aarhus, Denmark
- bDepartment of Clinical Medicine, Danish Center for Clinical Health Services Research, Aalborg University, Aalborg, Denmark
- cDepartment of Medical and Health Sciences, and Department of Cardiology, Linköping University, Linköping, Sweden
- dDepartment of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- eDepartment of Clinical Medicine, Aarhus University, Aarhus, Denmark
- ↵∗Address for correspondence:
Ms. Inge Schjødt, Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark.
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.
Supported by the Program for Clinical Research Infrastructure established by the Lundbeck Foundation and the Novo Nordisk Foundation and administered by Danish Regions (contract R3-038) and the Danish Nurses’ Organization Research Foundation. The financial sponsors had no role in any aspects of the study or in the drafting/approval of the manuscript. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 2, 2019.
- Revision received June 4, 2019.
- Accepted June 4, 2019.
- 2019 American College of Cardiology Foundation
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