Health inequalities in hospitalisation and mortality in patients diagnosed with heart failure in a universal healthcare coverage system

BackgroundInformation regarding the effect of social determinants of health on heart failure (HF) community-dwelling patients is scarce. We aimed to analyse the presence of socioeconomic inequalities, and their impact on hospitalisations and mortality, in patients with HF attended in a universal hea...

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Bibliographic Details
Published in:Journal of epidemiology and community health (1979) 2018-09, Vol.72 (9), p.845-851
Main Authors: Garcia, Raquel, Abellana, Rosa, Real, Jordi, del Val, José-Luis, Verdú-Rotellar, Jose Maria, Muñoz, Miguel-Angel
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Cardiovascular disease
Health risk assessment
Health Status Disparities
Heart diseases
Heart failure
Heart Failure - mortality
Hospitalization
Humans
Information systems
Medical Audit
Mortality
Proportional Hazards Models
Regression analysis
Research report
Retrospective Studies
Social Class
Socioeconomic factors
Spain - epidemiology
Universal Health Insurance
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Summary:BackgroundInformation regarding the effect of social determinants of health on heart failure (HF) community-dwelling patients is scarce. We aimed to analyse the presence of socioeconomic inequalities, and their impact on hospitalisations and mortality, in patients with HF attended in a universal healthcare coverage system.MethodsA retrospective cohort study carried out in patients with HF aged >40 and attended at the 53 primary healthcare centres of the Institut Català de la Salut in Barcelona (Spain). Socioeconomic status (SES) was determined by an aggregated deprivation index (MEDEA). Cox proportional hazard models and competing-risks regression based on Fine and Gray’s proportional subhazards were performed to analyse hospitalisations due to of HF and total mortality that occurred between 1 January 2009 and 31 December 2012.ResultsMean age was 78.1 years (SD 10.2) and 56% were women. Among the 8235 patients included, 19.4% died during the 4 years of follow-up and 27.1% were hospitalised due to HF. A gradient in the risk of hospitalisation was observed according to SES with the highest risk in the lowest socioeconomic group (sHR 1.46, 95% CI 1.27 to 1.68). Nevertheless, overall mortality did not differ among the socioeconomic groups.ConclusionsIn spite of finding a gradient that linked socioeconomic deprivation to an increased risk of hospitalisation, there were no differences in mortality regarding SES in a universal healthcare coverage system.
ISSN:0143-005X
1470-2738
DOI:10.1136/jech-2017-210146