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Health inequalities in hospitalisation and mortality in patients diagnosed with heart failure in a universal healthcare coverage system
  1. Raquel Garcia1,2,
  2. Rosa Abellana3,4,
  3. Jordi Real3,5,
  4. José-Luis del Val1,3,
  5. Jose Maria Verdú-Rotellar1,3,6,
  6. Miguel-Angel Muñoz1,2,3
  1. 1 Institut Català de la Salut, Barcelona, Spain
  2. 2 Departament de Pediatria, d’Obstetrícia i Ginecologia i de Medicina Preventiva, Facultat de Medicina, Universitat Autonoma de Barcelona, Bellaterra, Spain
  3. 3 Unitat de Suport a la Recerca de Barcelona, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
  4. 4 Fonaments Clinics, Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain
  5. 5 Epidemiologia i Salut Pública, Universitat Internacional de Catalunya, Sant Cugat, Spain
  6. 6 Departament de Medicina, Universitat Autonoma de Barcelona Facultat de Medicina, Bellaterra, Spain
  1. Correspondence to Dr Miguel-Angel Muñoz, Departament de Medicina, Universitat Autonoma de Barcelona Facultat de Medicina, Bellaterra 08025, Spain;{at}


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
  • hospitalisation
  • mortality

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  • 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.