Individual income, mortality and healthcare resource use in patients with chronic heart failure living in a universal healthcare system: A population-based study in Catalonia, Spain
Por:
Cainzos-Achirica M., Capdevila C., Vela E., Cleries M., Bilal U., Garcia-Altes A., Enjuanes C., Garay A., Yun S., Farre N., Corbella X., Comin-Colet J.
Publicada:
1 ene 2019
Resumen:
Background: To evaluate the associations between individual income, all-cause mortality and use of healthcare resources in a very large population of chronic heart failure (CHF) patients living in Catalonia (Spain), where access to public healthcare is granted by law. Methods and results: We used 2016 data from the Catalan Health Surveillance System, a large, exhaustive, administrative healthcare database which includes information on medical diagnoses, healthcare resource use, and individual income for all Catalan residents (N = 7,638,524). Individual annual income was categorized as high (>100,000€), medium (18,000–100,000€), low (<18,000€), and very low (welfare support). Among 155,883 CHF patients, lower individual income was associated with a shorter life expectancy at age 50 (life expectancy for high income patients 22.2 years, for very low income patients 12.8), and were independently associated with higher all-cause mortality adjusting for age, sex, comorbidities, and duration of the CHF diagnosis (odds ratio very low vs. medium income 1.21 [95% CI 1.11, 1.33]). Also, in patients with lower income levels the burden of public healthcare resource use was displaced towards urgent hospitalizations and frequent emergency department visits, as opposed to regular, specialized CHF ambulatory-based care. Conclusion: In a very large population of CHF patients with access to universal healthcare, lower income was independently associated with higher mortality and with lower use of ambulatory-based healthcare resources. Our findings suggest that CHF patients may benefit from systematic assessment of their socioeconomic status, as this may aid the identification of vulnerable subgroups who may benefit from tailored health education and management. © 2018 Elsevier B.V.
Filiaciones:
Cainzos-Achirica M.:
Community Heart Failure Program, Department of Cardiology, Bellvitge University Hospital and Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Department of Cardiology, Johns Hopkins Medical Institutions, Baltimore, MD, United States
RTI Health Solutions, Pharmacoepidemiology and Risk Management, Barcelona, Spain
Capdevila C.:
Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
Universitat de Barcelona, Barcelona, Spain
Vela E.:
Healthcare Information and Knowledge Unit, Catalan Health Service, Barcelona, Spain
Cleries M.:
Healthcare Information and Knowledge Unit, Catalan Health Service, Barcelona, Spain
Bilal U.:
Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, United States
Social and Cardiovascular Epidemiology Research Group, School of Medicine, University of Alcala, Alcala de Henares, Madrid, Spain
Garcia-Altes A.:
Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, Spain
CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
Enjuanes C.:
Community Heart Failure Program, Department of Cardiology, Bellvitge University Hospital and Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
Garay A.:
Community Heart Failure Program, Department of Cardiology, Bellvitge University Hospital and Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
Yun S.:
Community Heart Failure Program, Department of Cardiology, Bellvitge University Hospital and Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
Department of Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
Farre N.:
Heart Failure Unit, Department of Cardiology, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
Heart Diseases Biomedical Research Group (GREC), Hospital del Mar Biomedical Research Institute (IMIM), Barcelona, Spain
Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
Corbella X.:
Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
Department of Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
Hestia Chair in Integrated Health and Social Care, School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
Comin-Colet J.:
Community Heart Failure Program, Department of Cardiology, Bellvitge University Hospital and Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
Universitat de Barcelona, Barcelona, Spain
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