Background Information 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.
Methods A 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.
Results Mean 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.
Conclusions In 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.
- heart failure
- primary healthcare
- health inequalities
Statistics from Altmetric.com
Contributors RG, JMVR, RA and MAM designed the study protocol, wrote the first draft of the article and reviewed the final version. RA and JR performed statistical analyses and critically reviewed the final version of the article and the answer to the reviewers. JLV contributed to the interpretation of the results and to the review of the different drafts and final version.
Funding This study was granted by the Primary Care University Research Institute IDIAP Jordi Gol (4R13/016).
Competing interests None declared.
Patient consent Not required.
Ethics approval Comitè de etica del Institut Universitari de Recerca en Atenció Primaria IDIAP Jordi Gol.
Provenance and peer review Commissioned; externally peer reviewed.
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.