Income inequality and outcomes in heart failure: a global between-country analysis

Dewan, P. et al. (2019) Income inequality and outcomes in heart failure: a global between-country analysis. JACC: Heart Failure, 7(4), pp. 336-346. (doi: 10.1016/j.jchf.2018.11.005) (PMID:30738981)

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Abstract

Objectives: This study examined the relationship between income inequality and heart failure outcomes. Background: The income inequality hypothesis postulates that population health is influenced by income distribution within a society, with greater inequality associated with worse outcomes. Methods: This study analyzed heart failure outcomes in 2 large trials conducted in 54 countries. Countries were divided by tertiles of Gini coefficients (where 0% represented absolute income equality and 100% represented absolute income inequality), and heart failure outcomes were adjusted for standard prognostic variables, country per capita income, education index, hospital bed density, and health worker density. Results: Of the 15,126 patients studied, 5,320 patients lived in Gini coefficient tertile 1 countries (coefficient: <33%), 6,124 patients lived in tertile 2 countries (33% to 41%), and 3,772 patients lived in tertile 3 countries (>41%). Patients in tertile 3 were younger than tertile 1 patients, were more often women, and had less comorbidity and several indicators of less severe heart failure, yet the tertile 3-to-1 hazard ratios (HRs) for the primary composite outcome of cardiovascular death or heart failure hospitalization were 1.57 (95% confidence interval [CI]: 1.38 to 1.79) and 1.48 for all-cause death (95% CI: 1.29 to 1.71) after adjustment for recognized prognostic variables. After additional adjustments were made for per capita income, education index, hospital bed density, and health worker density, these HRs were 1.46 (95% CI: 1.25 to 1.70) and 1.30 (95% CI: 1.10 to 1.53), respectively. Conclusions: Greater income inequality was associated with worse heart failure outcomes, with an impact similar to those of major comorbidities. Better understanding of the societal and personal bases of these findings may suggest approaches to improve heart failure outcomes.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Roerth, Dr Rasmus and Dewan, Dr Pooja and Jhund, Dr Pardeep and Shen, Li and McMurray, Professor John and Kober, Professor Lars
Authors: Dewan, P., Rørth, R., Jhund, P. S., Ferreira, J. P., Zannad, F., Shen, L., Køber, L., Abraham, W. T., Desai, A. S., Dickstein, K., Packer, M., Rouleau, J. L., Solomon, S. D., Swedberg, K., Zile, M. R., and McMurray, J. J.V.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
Journal Name:JACC: Heart Failure
Publisher:Elsevier
ISSN:2213-1779
ISSN (Online):2213-1787
Published Online:06 February 2019
Copyright Holders:Copyright © 2019 The Authors
First Published:First published in JACC: Heart Failure 7(4):336-346
Publisher Policy:Reproduced under a Creative Commons License

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