Social determinants of health and cardiovascular outcomes in patients with heart failure.
atrial fibrillation
cardiovascular death
education
income
myocardial infarction
stroke
Journal
European journal of clinical investigation
ISSN: 1365-2362
Titre abrégé: Eur J Clin Invest
Pays: England
ID NLM: 0245331
Informations de publication
Date de publication:
11 2022
11 2022
Historique:
revised:
25
07
2022
received:
16
06
2022
accepted:
25
07
2022
pubmed:
5
8
2022
medline:
15
10
2022
entrez:
4
8
2022
Statut:
ppublish
Résumé
We examined the associations between family income and educational attainment with incident atrial fibrillation (AF), myocardial infarction (MI), stroke and cardiovascular (CV) death among patients with newly-diagnosed heart failure (HF). In a nationwide Danish registry of HF patients diagnosed between 2008 and 2018, we established a cohort for each outcome. When examining AF, MI and stroke, respectively, patients with a history of these outcomes at diagnosis of HF were excluded. We used cause-specific proportional hazard models to estimate hazard ratios for tertile groups of family income and three levels of educational attainment. Among 27,947 AF-free patients, we found no association between income or education and incident AF. Among 27,309 MI-free patients, we found that lower income (hazard ratio 1.28 [95% CI 1.11-1.48] and 1.11 [0.96-1.28] for lower and medium vs. higher income) and education (1.23 [1.04-1.45] and 1.15 [0.97-1.36] for lower and medium vs. higher education) were associated with MI. Among 36,801 stroke-free patients, lower income was associated with stroke (1.38 [1.23-1.56] and 1.27 [1.12-1.44] for lower and medium vs. higher income) but not education. Lower income (1.56 [1.46-1.67] and 1.32 [1.23-1.42] for lower and medium vs. higher income) and education (1.20 [1.11-1.29] and 1.07 [0.99-1.15] for lower and medium vs. higher education) were associated with CV death. In patients with newly-diagnosed HF, lower family income was associated with higher rates of acute MI, stroke and cardiovascular death. Lower educational attainment was associated with higher rates of acute MI and cardiovascular death. There was no evidence of associations between income and education with incident AF.
Sections du résumé
BACKGROUND
We examined the associations between family income and educational attainment with incident atrial fibrillation (AF), myocardial infarction (MI), stroke and cardiovascular (CV) death among patients with newly-diagnosed heart failure (HF).
METHODS
In a nationwide Danish registry of HF patients diagnosed between 2008 and 2018, we established a cohort for each outcome. When examining AF, MI and stroke, respectively, patients with a history of these outcomes at diagnosis of HF were excluded. We used cause-specific proportional hazard models to estimate hazard ratios for tertile groups of family income and three levels of educational attainment.
RESULTS
Among 27,947 AF-free patients, we found no association between income or education and incident AF. Among 27,309 MI-free patients, we found that lower income (hazard ratio 1.28 [95% CI 1.11-1.48] and 1.11 [0.96-1.28] for lower and medium vs. higher income) and education (1.23 [1.04-1.45] and 1.15 [0.97-1.36] for lower and medium vs. higher education) were associated with MI. Among 36,801 stroke-free patients, lower income was associated with stroke (1.38 [1.23-1.56] and 1.27 [1.12-1.44] for lower and medium vs. higher income) but not education. Lower income (1.56 [1.46-1.67] and 1.32 [1.23-1.42] for lower and medium vs. higher income) and education (1.20 [1.11-1.29] and 1.07 [0.99-1.15] for lower and medium vs. higher education) were associated with CV death.
CONCLUSIONS
In patients with newly-diagnosed HF, lower family income was associated with higher rates of acute MI, stroke and cardiovascular death. Lower educational attainment was associated with higher rates of acute MI and cardiovascular death. There was no evidence of associations between income and education with incident AF.
Identifiants
pubmed: 35924957
doi: 10.1111/eci.13843
pmc: PMC9786545
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e13843Informations de copyright
© 2022 The Authors. European Journal of Clinical Investigation published by John Wiley & Sons Ltd on behalf of Stichting European Society for Clinical Investigation Journal Foundation.
Références
Circulation. 2016 Feb 9;133(6):601-9
pubmed: 26858290
ESC Heart Fail. 2020 Oct;7(5):3095-3108
pubmed: 32767628
Eur Heart J. 2016 Jul 14;37(27):2129-2200
pubmed: 27206819
Int J Epidemiol. 2017 Jun 1;46(3):798-798f
pubmed: 27789670
J Epidemiol Community Health. 2006 Jan;60(1):7-12
pubmed: 16361448
Clin Epidemiol. 2013 Dec 23;6:27-36
pubmed: 24399886
Stat Med. 2009 Jul 10;28(15):1982-98
pubmed: 19452569
Lancet. 2018 Nov 10;392(10159):1789-1858
pubmed: 30496104
Eur J Clin Invest. 2010 Jan;40(1):35-53
pubmed: 20055895
Clin Epidemiol. 2015 Nov 17;7:449-90
pubmed: 26604824
Scand J Public Health. 2011 Jul;39(7 Suppl):30-3
pubmed: 21775347
Circulation. 2020 Jun 2;141(22):e841-e863
pubmed: 32349541
Br Med Bull. 2007;81-82:21-37
pubmed: 17284541
Lancet Public Health. 2019 Aug;4(8):e406-e420
pubmed: 31376859
Am J Prev Cardiol. 2022 Jan 12;9:100314
pubmed: 35399740
Circulation. 2018 May 15;137(20):2166-2178
pubmed: 29760227
Eur Heart J. 2021 Sep 21;42(36):3599-3726
pubmed: 34447992
Eur J Heart Fail. 2019 Nov;21(11):1306-1325
pubmed: 31523902
Lancet. 2008 Nov 8;372(9650):1661-9
pubmed: 18994664
Eur J Clin Invest. 2022 Nov;52(11):e13843
pubmed: 35924957
Heart. 2018 Jun;104(12):993-998
pubmed: 29386325
Scand J Public Health. 2011 Jul;39(7 Suppl):26-9
pubmed: 21775346
Clin Epidemiol. 2016 Oct 25;8:497-502
pubmed: 27822090
Dan Med Bull. 2006 Nov;53(4):441-9
pubmed: 17150149
BMJ Open. 2016 Nov 18;6(11):e012832
pubmed: 27864249
JACC Heart Fail. 2019 Sep;7(9):746-755
pubmed: 31466671
Eur J Heart Fail. 2020 Aug;22(8):1342-1356
pubmed: 32483830