Cuthbertson CC, Heiss G, Wright JD, Camplain R, Patel MD, Foraker RE, Matsushita K, Puccinelli-Ortega N, Shah AM, Kucharska-Newton AM. Socioeconomic status and access to care and the incidence of a heart failure diagnosis in the inpatient and outpatient settings.
Ann Epidemiol 2018;
28:350-355. [PMID:
29709334 PMCID:
PMC5971162 DOI:
10.1016/j.annepidem.2018.04.003]
[Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 04/04/2018] [Accepted: 04/10/2018] [Indexed: 12/29/2022]
Abstract
PURPOSE
Despite well-documented associations of socioeconomic status with incident heart failure (HF) hospitalization, little information exists on the relationship of socioeconomic status with HF diagnosed in the outpatient (OP) setting.
METHODS
We used Poisson models to examine the association of area-level indicators of educational attainment, poverty, living situation, and density of primary care physicians with incident HF diagnosed in the inpatient (IP) and OP settings among a cohort of Medicare beneficiaries (n = 109,756; 2001-2013).
RESULTS
The age-standardized rate of HF incidence was 35.8 (95% confidence interval [CI], 35.1-36.5) and 13.9 (95% CI, 13.5-14.4) cases per 1000 person-years in IP and OP settings, respectively. The incidence rate differences (IRDs) per 1000 person-years in both settings suggested greater incidence of HF in high- compared to low-poverty areas (IP IRD = 4.47 [95% CI, 3.29-5.65], OP IRD = 1.41 [95% CI, 0.61-2.22]) and in low- compared to high-education areas (IP IRD = 3.73 [95% CI, 2.63-4.82], OP IRD = 1.72 [95% CI, 0.97-2.47]).
CONCLUSIONS
Our results highlight the role of area-level social determinants of health in the incidence of HF in both the IP and OP settings. These findings may have implications for HF prevention policies.
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