Association of Neighborhood-Level Material Deprivation with Adverse Outcomes and Processes of Care Among Patients with Heart Failure in a Single-Payer Healthcare System: A Population-Based Cohort Study.
Journal
European journal of heart failure
ISSN: 1879-0844
Titre abrégé: Eur J Heart Fail
Pays: England
ID NLM: 100887595
Informations de publication
Date de publication:
13 Nov 2023
13 Nov 2023
Historique:
revised:
10
10
2023
received:
26
07
2023
accepted:
07
11
2023
medline:
13
11
2023
pubmed:
13
11
2023
entrez:
13
11
2023
Statut:
aheadofprint
Résumé
We studied the association between neighborhood material deprivation, a metric estimating inability to attain basic material needs, with outcomes and processes of care among incident heart failure (HF) patients in a universal healthcare system. In a population-based retrospective study (2007-2019), we examined the association of material deprivation with one-year all-cause mortality, cause-specific hospitalization, and 90-day processes of care. Using cause-specific hazards regression we quantified the relative rate of events after multiple covariate adjustment, stratifying by age ≤65 or ≥66 years. Among 395,763 patients (median age 76 [IQR 66-84] years, 47% women), there was significant interaction between age and deprivation quintile for mortality/hospitalization outcomes (P≤0.001). Younger residents (age ≤65 years) of the most versus least deprived neighborhoods had higher hazards of all-cause death (HR 1.19 [95%CI, 1.10-1.29]) and cardiovascular hospitalization (HR 1.29 [95%CI, 1.19-1.39]). Older individuals (≥66 years) in the most deprived neighbourhoods had significantly higher hazard of death (HR 1.11 [95%CI, 1.08-1.14]) and cardiovascular hospitalization (HR 1.13 [95%CI, 1.09-1.18]) compared to the least deprived. The magnitude of the association between deprivation and outcomes was amplified in the younger compared to the older age group. More deprived individuals in both age groups had a lower hazard of cardiology visits and advanced cardiac imaging (all P<0.001), while the most deprived of younger ages were less likely to undergo ICD/CRT-P implantation (P=0.023), compared to the least deprived. Patients with newly-diagnosed HF residing in the most deprived neighborhoods had worse outcomes and reduced access to care than those less deprived. This article is protected by copyright. All rights reserved.
Sections du résumé
BACKGROUND
BACKGROUND
We studied the association between neighborhood material deprivation, a metric estimating inability to attain basic material needs, with outcomes and processes of care among incident heart failure (HF) patients in a universal healthcare system.
METHODS
METHODS
In a population-based retrospective study (2007-2019), we examined the association of material deprivation with one-year all-cause mortality, cause-specific hospitalization, and 90-day processes of care. Using cause-specific hazards regression we quantified the relative rate of events after multiple covariate adjustment, stratifying by age ≤65 or ≥66 years.
RESULTS
RESULTS
Among 395,763 patients (median age 76 [IQR 66-84] years, 47% women), there was significant interaction between age and deprivation quintile for mortality/hospitalization outcomes (P≤0.001). Younger residents (age ≤65 years) of the most versus least deprived neighborhoods had higher hazards of all-cause death (HR 1.19 [95%CI, 1.10-1.29]) and cardiovascular hospitalization (HR 1.29 [95%CI, 1.19-1.39]). Older individuals (≥66 years) in the most deprived neighbourhoods had significantly higher hazard of death (HR 1.11 [95%CI, 1.08-1.14]) and cardiovascular hospitalization (HR 1.13 [95%CI, 1.09-1.18]) compared to the least deprived. The magnitude of the association between deprivation and outcomes was amplified in the younger compared to the older age group. More deprived individuals in both age groups had a lower hazard of cardiology visits and advanced cardiac imaging (all P<0.001), while the most deprived of younger ages were less likely to undergo ICD/CRT-P implantation (P=0.023), compared to the least deprived.
CONCLUSION
CONCLUSIONS
Patients with newly-diagnosed HF residing in the most deprived neighborhoods had worse outcomes and reduced access to care than those less deprived. This article is protected by copyright. All rights reserved.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
This article is protected by copyright. All rights reserved.