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Witt CT, Mols RE, Bakos I, Horváth-Puhó E, Christensen B, Løgstrup BB, Nielsen JC, Eiskjær H. Influence of multimorbidity and socioeconomic position on long-term healthcare utilization and prognosis in patients after cardiac resynchronization therapy implantation. EUROPEAN HEART JOURNAL OPEN 2024; 4:oeae029. [PMID: 38828270 PMCID: PMC11143480 DOI: 10.1093/ehjopen/oeae029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/01/2024] [Accepted: 03/14/2024] [Indexed: 06/05/2024]
Abstract
Aims We aimed to investigate the influence of socioeconomic position (SEP) and multimorbidity on cross-sectional healthcare utilization and prognosis in patients after cardiac resynchronization therapy (CRT) implantation. Methods and results We included first-time CRT recipients with left ventricular ejection fraction ≤35% implanted between 2000 and 2017. Data on chronic conditions, use of healthcare services, and demographics were obtained from Danish national administrative and health registries. Healthcare utilization (in- and outpatient hospitalizations, activities in general practice) was compared by multimorbidity categories and SEP by using a negative binomial regression model. The association between SEP, multimorbidity, and prognostic outcomes was analysed using Cox proportional hazards regression. We followed 2007 patients (median age of 70 years), 79% were male, 75% were on early retirement or state pension, 37% were living alone, and 41% had low education level for a median of 5.2 [inter-quartile range: 2.2-7.3) years. In adjusted regression models, a higher number of chronic conditions were associated with increased healthcare utilization. Both cardiovascular and non-cardiovascular hospital contacts were increased. Patients with low SEP had a higher number of chronic conditions, but SEP had limited influence on healthcare utilization. Patients living alone and those with low educational level had a trend towards a higher risk of all-cause mortality [adjusted hazard ratio (aHR): 1.17, 95% confidence interval (CI) 1.03-1.33, and aHR 1.09, 95% CI 0.96-1.24). Conclusion Multimorbidity increased the use of cross-sectional healthcare services, whereas low SEP had minor influence on the utilizations. Living alone and low educational level showed a trend towards a higher risk of mortality after CRT implantation.
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Affiliation(s)
- Christoffer Tobias Witt
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Rikke Elmose Mols
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - István Bakos
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark
| | - Erzsébet Horváth-Puhó
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark
| | - Bo Christensen
- Department of Public Health, Research Unit for General Practice, Aarhus University Bartholins Allé 2, 8000 Aarhus C, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark
| | - Brian Bridal Løgstrup
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark
| | - Jens Cosedis Nielsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark
| | - Hans Eiskjær
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200 Aarhus N, Denmark
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Dalla Zuanna T, Cacciani L, Barbieri G, Batzella E, Tona F, Ferracin E, Spadea T, Di Girolamo C, Caranci N, Petrelli A, Marino C, Canova C. Avoidable Hospitalization for Heart Failure Among a Cohort of 18- to 64-Year-Old Italian Citizens and Immigrants: Results From the Italian Network for Longitudinal Metropolitan Studies. Circ Heart Fail 2021; 14:e008022. [PMID: 34235937 DOI: 10.1161/circheartfailure.120.008022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Heart failure (HF) represents a severe public health burden. In Europe, differences in hospitalizations for HF have been found between immigrants and native individuals, with inconsistent results. Immigrants face many barriers in their access to health services, and their needs may be poorly met. We aimed to compare the rates of avoidable hospitalization for HF among immigrants and native individuals in Italy. METHODS All 18- to 64-year-old residents of Turin, Venice, Reggio Emilia, Modena, Bologna, and Rome between January 1, 2001 and December 31, 2013 were included in this multicenter open-cohort study. Immigrants from high migratory pressure countries (divided by area of origin) were compared with Italian citizens. Age-, sex-, and calendar year-adjusted hospitalization rate ratios and the 95% CIs of avoidable hospitalization for HF by citizenship were estimated using negative binomial regression models. The hospitalization rate ratios were summarized using a random effects meta-analysis. Additionally, we tested the contribution of socioeconomic status to these disparities. RESULTS Of the 4 470 702 subjects included, 15.8% were immigrants from high migratory pressure countries. Overall, immigrants showed a nonsignificant increased risk of avoidable hospitalization for HF (hospitalization rate ratio, 1.26 [95% CI, 0.97-1.68]). Risks were higher for immigrants from Sub-Saharan Africa and for males from Northern Africa and Central-Eastern Europe than for their Italian citizen counterparts. Risks were attenuated adjusting for socioeconomic status, although they remained consistent with nonadjusted results. CONCLUSIONS Adult immigrants from different geographic macroareas had higher risks of avoidable hospitalization for HF than Italian citizens. Possible explanations might be higher risk factors among immigrants and reduced access to primary health care services.
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Affiliation(s)
- Teresa Dalla Zuanna
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy (T.D.Z., G.B., E.B., C.C.)
| | - Laura Cacciani
- Department of Epidemiology, Regional Health Service, Lazio Region, Rome, Italy (L.C., C.M.)
| | - Giulia Barbieri
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy (T.D.Z., G.B., E.B., C.C.)
| | - Erich Batzella
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy (T.D.Z., G.B., E.B., C.C.)
| | - Francesco Tona
- Department of Cardiac, Thoracic and Vascular Sciences, Padova University-Hospital, Italy (F.T.)
| | - Elisa Ferracin
- Epidemiology Department, Local Health Unit TO3, Piedmont Region, Grugliasco, Turin, Italy (E.F., T.S.)
| | - Teresa Spadea
- Epidemiology Department, Local Health Unit TO3, Piedmont Region, Grugliasco, Turin, Italy (E.F., T.S.)
| | - Chiara Di Girolamo
- Regional Health and Social Care Agency, Emilia-Romagna Region, Bologna, Italy (C.D.G., N.C.)
| | - Nicola Caranci
- Regional Health and Social Care Agency, Emilia-Romagna Region, Bologna, Italy (C.D.G., N.C.)
| | - Alessio Petrelli
- National Institute for Health, Migration and Poverty (INMP), Rome, Italy (A.P.)
| | - Claudia Marino
- Department of Epidemiology, Regional Health Service, Lazio Region, Rome, Italy (L.C., C.M.)
| | - Cristina Canova
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padua, Italy (T.D.Z., G.B., E.B., C.C.)
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Narita K, Amiya E. Social and environmental risks as contributors to the clinical course of heart failure. Heart Fail Rev 2021; 27:1001-1016. [PMID: 33945055 DOI: 10.1007/s10741-021-10116-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/22/2021] [Indexed: 11/28/2022]
Abstract
Heart failure is a major contributor to healthcare expenditures. Many clinical risk factors for the development and exacerbation of heart failure had been reported, including diabetes, renal dysfunction, and respiratory disease. In addition to these clinical parameters, the effects of social factors, such as occupation or lifestyle, and environmental factors may have a great impact on disease development and progression of heart failure. However, the current understanding of social and environmental factors as contributors to the clinical course of heart failure is insufficient. To present the knowledge of these factors to date, this comprehensive review of the literature sought to identify the major contributors to heart failure within this context. Social factors for the risk of heart failure included occupation and lifestyle, specifically in terms of the effects of specific occupations, occupational exposure to toxicities, work style, and sleep deprivation. Socioeconomic factors focused on income and education level, social status, the neighborhood environment, and marital status. Environmental factors included traffic and noise, air pollution, and other climate factors. In addition, psychological stress and behavior traits were investigated. The development of heart failure may be closely related to these factors; therefore, these data should be summarized for the context to improve their effects on patients with heart failure. The present study reviews the literature to summarize these influences.
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Affiliation(s)
- Koichi Narita
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, 113-8655, Tokyo, Japan
| | - Eisuke Amiya
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, 113-8655, Tokyo, Japan. .,Department of Therapeutic Strategy for Heart Failure, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, 113-8655, Tokyo, Japan.
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Davari M, Maracy MR, Khorasani E. Socioeconomic status, cardiac risk factors, and cardiovascular disease: A novel approach to determination of this association. ARYA ATHEROSCLEROSIS 2020; 15:260-266. [PMID: 32206069 PMCID: PMC7073799 DOI: 10.22122/arya.v15i6.1595] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Socioeconomic inequality is one of the important issues in cardiovascular diseases (CVDs). The aim of this study was to investigate the distribution and relation between selected cardiac risk factors, type of CVD, and the socioeconomic status (SES) in the hospitalized patients with heart disease in Isfahan, Iran. METHODS This analytical and cross-sectional study was conducted in Isfahan in 2013. The population consisted of all patients with CVD admitted to the public and private hospitals. The sample size was 721. Data collection was conducted through one researcher-made questionnaire with three sections: demographic, disease, and SES questionnaires. To determine the SES of the patients, the indicators of income, housing status, occupation, family size, and education were used. Data analysis was conducted in two statistical levels of descriptive and inferential. RESULTS 69.1% of the patients were placed in the poor status, and there was no wealthy status within the subjects. The five most frequent CVDs were chronic ischemia, unstable angina, arrhythmia, congestive heart failure (CHF), and acute myocardial infarction (MI), respectively. The three highest frequent risk factors in the patients were hypertension (HTN) (47.2%), diabetes (33.6%), and hyperlipidemia (32.6%). Regression analysis of the risk factors and the type of heart disease on the SES revealed that there were statistically significant differences between patients who were smokers (P = 0.030) and those who had valve disease (P = 0.010), adjusted for age, gender, and marital status. CONCLUSION Our findings showed that the frequency of CVD risk factors were higher in lower SES groups and thus SES can be a strong predictor for the occurrence of the CVD risk factors as well as the CVDs.
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Affiliation(s)
- Majid Davari
- Assistant Professor, Pharmaceutical Management and Economic Research Center AND Department of Pharmacoeconomics and Pharmaceutical Administration, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Maracy
- Professor, Department of Epidemiology and Biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Elahe Khorasani
- PhD Candidate, Students' Scientific Research Center AND Department of Pharmacoeconomics and Pharmaceutical Administration, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
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Mehta NK, Martikainen P, Cederström A. Age at Immigration, Generational Status, and Death Among Children of Immigrant Mothers: A Longitudinal Analysis of Siblings. Am J Epidemiol 2019; 188:1237-1244. [PMID: 30834450 DOI: 10.1093/aje/kwz055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 02/24/2019] [Accepted: 02/25/2019] [Indexed: 11/13/2022] Open
Abstract
Studies have documented that age at immigration and generational status are important predictors of socioeconomic outcomes among children of immigrants. Whether these characteristics are related to long-term risk of death is unknown. Leveraging variation within sibships, we evaluated the association of age at immigration and generational status (i.e., first or second generation) with death among children of immigrant mothers to Sweden. Data included 272,429 individuals (126,701 sibships) aged 15 or more years from the total Swedish population followed between 1990 and 2009. Population-average and sibling fixed-effect regressions were estimated, with the latter controlling for unobserved factors shared by siblings. The foreign-born children of immigrants experienced a 17% higher risk of death than the Swedish-born children of immigrants. This excess risk was evident for external and nonexternal causes of death. In general, a graded association was not detected between age at immigration and death among the foreign-born individuals; however, those arriving during primary school ages appeared especially vulnerable. This study provides robust evidence that among children of immigrants, being foreign born was associated with a long-term death penalty compared with being born in the host country.
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Affiliation(s)
- Neil K Mehta
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Pekka Martikainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Finland
- Department of Public Health Sciences, Stockholm University, Sweden
- The Max Planck Institute for Demographic Research, Germany
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Incidence of Heart Failure Among Immigrants to Ontario, Canada: A CANHEART Immigrant Study. J Card Fail 2019; 25:425-435. [PMID: 30877039 DOI: 10.1016/j.cardfail.2019.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 03/07/2019] [Accepted: 03/08/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND Several known traditional cardiovascular risk factors contribute to the development of heart failure (HF); however, whether ethnicity is also an important predictor is not well established. We determined the incidence of hospitalization for HF among ethnic groups in Ontario, Canada, and examined differences in risk factor prevalence that may contribute to disparities in HF hospitalization incidence between groups. METHODS AND RESULTS We conducted a retrospective observational study from 2008 to 2012 with the use of a linked cohort derived from population-based health administrative, clinical, and survey datasets. We followed 895,823 recent immigrants from 8 ethnic groups and 5.3 million long-term residents aged 40-105 years for incident HF hospitalization. Sex-stratified age-standardized HF incidence was lower among all immigrant groups than long-term residents. Among immigrants, Black men and West Asian women had the highest incidence of hospitalizations for HF (1.19 and 1.60 per 1000 person-years, respectively), and East Asians of both sexes had the lowest incidence. After adjusting for sociodemographic characteristics, comorbidities, and other risk factors, the association between ethnicity and HF hospitalization risk remained significant. CONCLUSIONS HF hospitalization incidence varies widely among ethnic immigrant groups, highlighting the importance of ethnicity as a potential independent risk factor for HF development.
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Wändell P, Carlsson AC, Li X, Gasevic D, Ärnlöv J, Holzmann MJ, Sundquist J, Sundquist K. Heart failure in immigrant groups: a cohort study of adults aged 45 years and over in Sweden. SCAND CARDIOVASC J 2018; 52:292-300. [PMID: 30445882 DOI: 10.1080/14017431.2018.1546892] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE An increased risk of being diagnosed with coronary heart disease or atrial fibrillation has been shown among different immigrant groups. However, less is known on the risk of being diagnosed with congestive heart failure (CHF). DESIGN We studied CHF in immigrants including all adults ≥45 years in Sweden (n = 3,274,119) from 1998 to 2012. CHF was defined as at the first event registered in the National Patient Register. Risk of incident CHF in immigrant groups compared to the Swedish-born population was assessed by Cox regression, stratified by sex, adjusting for age, socio-demographic status, and co-morbidities. RESULTS During a mean follow-up of 14 years in total, a total of 302,340 (9.2%) events of CHF were registered. We found the following: higher incidence in men from Bosnia, Iraq, Lebanon, Russia and Africa; among women from Bosnia, Iraq, Lebanon, Turkey, Central Europe and Finland; lower incidence in men from Iceland, Latin America, Southern Europe, Norway and Western Europe; and among women from Iceland, Southern Europe, Norway, Denmark and Western Europe. CONCLUSION It is important to be aware of the increased incidence of CHF in some immigrant groups, especially from countries and areas where the immigrants have been refugees, in order to enable for a timely diagnosis, treatment of and prevention of CHF and its debilitating complications.
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Affiliation(s)
- Per Wändell
- a Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society , Karolinska Institutet , Huddinge , Sweden
| | - Axel C Carlsson
- a Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society , Karolinska Institutet , Huddinge , Sweden
| | - Xinjun Li
- b Center for Primary Health Care Research , Lund University , Malmö , Sweden
| | - Danijela Gasevic
- c Usher Institute of Population Health Sciences and Informatics, College of Medicine and Veterinary Medicine , University of Edinburgh , Edinburgh , UK.,d School of Public Health and Preventive Medicine , Monash University , Melbourne , Australia
| | - Johan Ärnlöv
- a Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society , Karolinska Institutet , Huddinge , Sweden.,e School of Health and Social Studies , Dalarna University , Falun , Sweden
| | - Martin J Holzmann
- f Functional Area of Emergency Medicine , Karolinska University Hospital , Stockholm , Sweden.,g Department of Internal Medicine Solna , Karolinska Institutet , Stockholm , Sweden
| | - Jan Sundquist
- b Center for Primary Health Care Research , Lund University , Malmö , Sweden.,h Department of Family Medicine and Community Health, Department of Population Health Science and Policy , Icahn School of Medicine at Mount Sinai , New York , NY , USA.,i Center for Community-based Healthcare Research and Education (CoHRE), Department of Functional Pathology, School of Medicine , Shimane University , Matsue , Japan
| | - Kristina Sundquist
- b Center for Primary Health Care Research , Lund University , Malmö , Sweden.,h Department of Family Medicine and Community Health, Department of Population Health Science and Policy , Icahn School of Medicine at Mount Sinai , New York , NY , USA.,i Center for Community-based Healthcare Research and Education (CoHRE), Department of Functional Pathology, School of Medicine , Shimane University , Matsue , Japan
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The Prevalence and Associated Distress of Physical and Psychological Symptoms in Patients With Advanced Heart Failure Attending a South African Medical Center. J Cardiovasc Nurs 2018; 31:313-22. [PMID: 25829136 DOI: 10.1097/jcn.0000000000000256] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Despite the high prevalence of heart failure in low- and middle-income countries, evidence concerning patient-reported burden of disease in advanced heart failure is lacking. OBJECTIVE The aim of this study is to measure patient-reported symptom prevalence and correlates of symptom burden in patients with advanced heart failure. METHODS Adult patients diagnosed with New York heart Association (NYHA) stage III or IV heart failure were recruited from the emergency unit, emergency ward, cardiology ward, general medicine wards, and outpatient cardiology clinic of a public hospital in South Africa. Patients were interviewed by researchers using the Memorial Symptom Assessment Scale-Short Form, a well-validated multidimensional instrument that assesses presence and distress of 32 symptoms. RESULTS A total of 230 patients (response, 99.1%), 90% NYHA III and 10% NYHA IV (12% newly diagnosed), with a mean age of 58 years, were included. Forty-five percent were women, 14% had completed high school, and 26% reported having no income. Mean Karnofsky Performance Status Score was 50%. Patients reported a mean of 19 symptoms. Physical symptoms with a high prevalence were shortness of breath (95.2%), feeling drowsy/tired (93.0%), and pain (91.3%). Psychological symptoms with a high prevalence were worrying (94.3%), feeling irritable (93.5%), and feeling sad (93.0%). Multivariate linear regression analyses, with total number of symptoms as dependent variable, showed no association between number of symptoms and gender, education, number of healthcare contacts in the last 3 months, years since diagnosis, or comorbidities. Increased number of symptoms was significantly associated with higher age (b = 0.054, P = .042), no income (b = -2.457, P = .013), and fewer hospitalizations in the last 12 months (b = -1.032, P = .017). CONCLUSIONS Patients with advanced heart failure attending a medical center in South Africa experience high prevalence of symptoms and report high levels of burden associated with these symptoms. Improved compliance with national and global treatment recommendations could contribute to reduced symptom burden. Healthcare professionals should consider incorporating palliative care into the care for these patients.
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Witte KK, Patel PA, Walker AMN, Schechter CB, Drozd M, Sengupta A, Byrom R, Kearney LC, Sapsford RJ, Kearney MT, Cubbon RM. Socioeconomic deprivation and mode-specific outcomes in patients with chronic heart failure. Heart 2018; 104:993-998. [PMID: 29386325 PMCID: PMC5992368 DOI: 10.1136/heartjnl-2017-312539] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 12/07/2017] [Accepted: 12/21/2017] [Indexed: 12/26/2022] Open
Abstract
Objective To characterise the association between socioeconomic deprivation and adverse outcomes in patients with chronic heart failure (CHF). Methods We prospectively observed 1802 patients with CHF and left ventricular ejection fraction (LVEF) ≤45%, recruited in four UK hospitals between 2006 and 2014. We assessed the association between deprivation defined by the UK Index of Multiple Deprivation (IMD) and: mode-specific mortality (mean follow-up 4 years); mode-specific hospitalisation; and the cumulative duration of hospitalisation (after 1 year). Results A 45-point difference in mean IMD score was noted between patients residing in the least and most deprived quintiles of geographical regions. Deprivation was associated with age, sex and comorbidity, but not CHF symptoms, LVEF or prescribed drug therapy. IMD score was associated with the risk of age-sex adjusted all-cause mortality (6% higher risk per 10-unit increase in IMD score; 95% CI 2% to 10%; P=0.004), and non-cardiovascular mortality (9% higher risk per 10-unit increase in IMD score; 95% CI 3% to 16%; P=0.003), but not cardiovascular mortality. All-cause, but not heart failure-specific, hospitalisation was also more common in the most deprived patients. Overall, patients spent a cumulative 3.3 days in hospital during 1 year of follow-up, with IMD score being associated with the age-sex adjusted cumulative duration of hospitalisations (4% increase in duration per 10-unit increase in IMD score; 95% CI 3% to 6%; P<0.0005). Conclusions Socioeconomic deprivation in people with CHF is linked to increased risk of death and hospitalisation due to an excess of non-cardiovascular events.
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Affiliation(s)
- Klaus K Witte
- Multidisciplinary Cardiovascular Research Centre, The University of Leeds, Leeds, UK
| | - Peysh A Patel
- Multidisciplinary Cardiovascular Research Centre, The University of Leeds, Leeds, UK
| | - Andrew M N Walker
- Multidisciplinary Cardiovascular Research Centre, The University of Leeds, Leeds, UK
| | - Clyde B Schechter
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Michael Drozd
- Multidisciplinary Cardiovascular Research Centre, The University of Leeds, Leeds, UK
| | - Anshuman Sengupta
- Multidisciplinary Cardiovascular Research Centre, The University of Leeds, Leeds, UK
| | - Rowenna Byrom
- Multidisciplinary Cardiovascular Research Centre, The University of Leeds, Leeds, UK
| | - Lorraine C Kearney
- Multidisciplinary Cardiovascular Research Centre, The University of Leeds, Leeds, UK
| | | | - Mark T Kearney
- Multidisciplinary Cardiovascular Research Centre, The University of Leeds, Leeds, UK
| | - Richard M Cubbon
- Multidisciplinary Cardiovascular Research Centre, The University of Leeds, Leeds, UK
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Schlyter M, Östman M, Engström G, André-Petersson L, Tydén P, Leosdottir M. Personality factors and depression as predictors of hospital-based health care utilization following acute myocardial infarction. Eur J Cardiovasc Nurs 2016; 16:318-325. [DOI: 10.1177/1474515116666780] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Mona Schlyter
- Department of Cardiology, Skåne University Hospital and Lund University, Lund and Malmö, Sweden
- Faculty of Health and Society, Malmö University, Sweden
| | | | - Gunnar Engström
- Cardiovascular Epidemiology Research Group, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | | | - Patrik Tydén
- Department of Cardiology, Skåne University Hospital and Lund University, Lund and Malmö, Sweden
| | - Margrét Leosdottir
- Department of Cardiology, Skåne University Hospital and Lund University, Lund and Malmö, Sweden
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11
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Borné Y, Persson M, Melander O, Smith JG, Engström G. Increased plasma level of soluble urokinase plasminogen activator receptor is associated with incidence of heart failure but not atrial fibrillation. Eur J Heart Fail 2015; 16:377-83. [PMID: 24464777 DOI: 10.1002/ejhf.49] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Revised: 11/08/2013] [Accepted: 11/15/2013] [Indexed: 11/10/2022] Open
Abstract
AIMS Soluble urokinase plasminogen activator receptor (suPAR) in plasma is a novel inflammatory marker thought to be released from the cell surface of neutrophils, T cells, and macrophages. Other inflammatory markers, mainly acute phase proteins produced in the liver, have been associated with the incidence of heart failure (HF) and atrial fibrillation (AF). We investigated the association between suPAR and incident HF and AF in a population-based cohort. METHODS AND RESULTS Soluble urokinase plasminogen activator receptor was measured in 4530 subjects (aged 46–68 years, 61% women), who participated in the Malmö Diet and Cancer study during 1991–1996. Incident cases of HF and AF were identified from the Swedish hospital discharge register during a median follow-up of 16.3 years. During follow-up, 109 subjects (55% men) were diagnosed with new-onset HF and 321 individuals (50% men) with AF. suPAR was significantly associated with increased plasma levels of NT-proBNP (P<0.001). suPAR was significantly associated with incidence of HF [hazard ratio (HR) for the third vs. first tertile 3.33, 95% confidence interval (CI) 1.91–5.81 after adjustment for age and sex; and HR 1.82, 95% CI 1.02–3.27, P for trend 0.018 after adjustment for conventional risk factors and biomarkers]. suPAR was significantly associated with incidence of AF, when adjusted for age and sex (HR 1.40, 95% CI 1.06–1.85). However, this relationship was non-significant after adjustment for conventional risk factors and biomarkers. CONCLUSION Soluble urokinase plasminogen activator receptor was associated with increased plasma levels of NT-proBNP and incidence of HF, but not with AF among middle-aged subjects.
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Vivo RP, Krim SR, Liang L, Neely M, Hernandez AF, Eapen ZJ, Peterson ED, Bhatt DL, Heidenreich PA, Yancy CW, Fonarow GC. Short- and long-term rehospitalization and mortality for heart failure in 4 racial/ethnic populations. J Am Heart Assoc 2014; 3:e001134. [PMID: 25324354 PMCID: PMC4323790 DOI: 10.1161/jaha.114.001134] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The degree to which outcomes following hospitalization for acute heart failure (HF) vary by racial and ethnic groups is poorly characterized. We sought to compare 30‐day and 1‐year rehospitalization and mortality rates for HF among 4 race/ethnic groups. Methods and Results Using the Get With The Guidelines–HF registry linked with Medicare data, we compared 30‐day and 1‐year outcomes between racial/ethnic groups by using a multivariable Cox proportional hazards model adjusting for clinical, hospital, and socioeconomic status characteristics. We analyzed 47 149 Medicare patients aged ≥65 years who had been discharged for HF between 2005 and 2011: there were 39 213 whites (83.2%), 4946 blacks (10.5%), 2347 Hispanics (5.0%), and 643 Asians/Pacific Islanders (1.4%). Relative to whites, blacks and Hispanics had higher 30‐day and 1‐year unadjusted readmission rates but lower 30‐day and 1‐year mortality; Asians had similar 30‐day readmission rates but lower 1‐year mortality. After risk adjustment, blacks had higher 30‐day and 1‐year CV readmission than whites but modestly lower short‐ and long‐term mortality; Hispanics had higher 30‐day and 1‐year readmission rates and similar 1‐year mortality than whites, while Asians had similar outcomes. When socioeconomic status data were added to the model, the majority of associations persisted, but the difference in 30‐day and 1‐year readmission rates between white and Hispanic patients became nonsignificant. Conclusions Among Medicare patients hospitalized with HF, short‐ and long‐term readmission rates and mortality differed among the 4 major racial/ethnic populations and persisted even after controlling for clinical, hospital, and socioeconomic status variables.
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Affiliation(s)
- Rey P Vivo
- Ronald Reagan-UCLA Medical Center, Los Angeles, CA (R.P.V., G.C.F.)
| | - Selim R Krim
- Ochsner Heart and Vascular Institute, New Orleans, LA (S.R.K.)
| | - Li Liang
- Duke Clinical Research Institute, Durham, NC (L.L., M.N., A.F.H., Z.J.E., E.D.P.)
| | - Megan Neely
- Duke Clinical Research Institute, Durham, NC (L.L., M.N., A.F.H., Z.J.E., E.D.P.)
| | - Adrian F Hernandez
- Duke Clinical Research Institute, Durham, NC (L.L., M.N., A.F.H., Z.J.E., E.D.P.)
| | - Zubin J Eapen
- Duke Clinical Research Institute, Durham, NC (L.L., M.N., A.F.H., Z.J.E., E.D.P.)
| | - Eric D Peterson
- Duke Clinical Research Institute, Durham, NC (L.L., M.N., A.F.H., Z.J.E., E.D.P.)
| | - Deepak L Bhatt
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA (D.L.B.)
| | - Paul A Heidenreich
- VA Palo Alto Health Care System, 3801 Miranda Ave., Palo Alto, CA (P.A.H.)
| | - Clyde W Yancy
- Northwestern University Feinberg School of Medicine, Chicago, IL (C.W.Y.)
| | - Gregg C Fonarow
- Ronald Reagan-UCLA Medical Center, Los Angeles, CA (R.P.V., G.C.F.)
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13
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Borné Y, Smith JG, Melander O, Hedblad B, Engström G. Red cell distribution width and risk for first hospitalization due to heart failure: a population-based cohort study. Eur J Heart Fail 2014; 13:1355-61. [DOI: 10.1093/eurjhf/hfr127] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Yan Borné
- Department of Clinical Sciences; Lund University, Clinical Research Center (CRC), Entrence 72, house 60, level 13, Skåne University Hospital; SE 205 02 Malmö Sweden
| | - J. Gustav Smith
- Program of Medical and Population Genetics; Broad Institute of MIT and Harvard; Cambridge MA USA
| | - Olle Melander
- Department of Clinical Sciences; Lund University, Clinical Research Center (CRC), Entrence 72, house 60, level 13, Skåne University Hospital; SE 205 02 Malmö Sweden
| | - Bo Hedblad
- Department of Clinical Sciences; Lund University, Clinical Research Center (CRC), Entrence 72, house 60, level 13, Skåne University Hospital; SE 205 02 Malmö Sweden
| | - Gunnar Engström
- Department of Clinical Sciences; Lund University, Clinical Research Center (CRC), Entrence 72, house 60, level 13, Skåne University Hospital; SE 205 02 Malmö Sweden
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14
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Hofman A, Darwish Murad S, van Duijn CM, Franco OH, Goedegebure A, Ikram MA, Klaver CCW, Nijsten TEC, Peeters RP, Stricker BHC, Tiemeier HW, Uitterlinden AG, Vernooij MW. The Rotterdam Study: 2014 objectives and design update. Eur J Epidemiol 2013; 28:889-926. [PMID: 24258680 DOI: 10.1007/s10654-013-9866-z] [Citation(s) in RCA: 259] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 11/08/2013] [Indexed: 02/06/2023]
Abstract
The Rotterdam Study is a prospective cohort study ongoing since 1990 in the city of Rotterdam in The Netherlands. The study targets cardiovascular, endocrine, hepatic, neurological, ophthalmic, psychiatric, dermatological, oncological, and respiratory diseases. As of 2008, 14,926 subjects aged 45 years or over comprise the Rotterdam Study cohort. The findings of the Rotterdam Study have been presented in over a 1,000 research articles and reports (see www.erasmus-epidemiology.nl/rotterdamstudy ). This article gives the rationale of the study and its design. It also presents a summary of the major findings and an update of the objectives and methods.
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Affiliation(s)
- Albert Hofman
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands,
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15
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Santos M, Ravn-Fischer A, Karlsson T, Herlitz J, Bergman B. Is early treatment of acute chest pain provided sooner to patients who speak the national language? Int J Qual Health Care 2013; 25:582-9. [DOI: 10.1093/intqhc/mzt055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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16
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Jaddoe VWV, van Duijn CM, Franco OH, van der Heijden AJ, van Iizendoorn MH, de Jongste JC, van der Lugt A, Mackenbach JP, Moll HA, Raat H, Rivadeneira F, Steegers EAP, Tiemeier H, Uitterlinden AG, Verhulst FC, Hofman A. The Generation R Study: design and cohort update 2012. Eur J Epidemiol 2012. [PMID: 23086283 DOI: 10.1007/s10654‐012‐9735‐1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The Generation R Study is a population-based prospective cohort study from fetal life until adulthood. The study is designed to identify early environmental and genetic causes and causal pathways leading to normal and abnormal growth, development and health during fetal life, childhood and adulthood. The study focuses on six areas of research: (1) maternal health; (2) growth and physical development; (3) behavioural and cognitive development; (4) respiratory health and allergies; (5) diseases in childhood; and (6) health and healthcare for children and their parents. Main exposures of interest include environmental, endocrine, genetic and epigenetic, lifestyle related, nutritional and socio-demographic determinants. In total, n = 9,778 mothers with a delivery date from April 2002 until January 2006 were enrolled in the study. Response at baseline was 61 %, and general follow-up rates until the age of 6 years exceed 80 %. Data collection in mothers, fathers and children include questionnaires, detailed physical and ultrasound examinations, behavioural observations, and biological samples. A genome and epigenome wide association screen is available in the participating children. From the age of 5 years, regular detailed hands-on assessments are performed in a dedicated research center including advanced imaging facilities such as Magnetic Resonance Imaging. Eventually, results forthcoming from the Generation R Study contribute to the development of strategies for optimizing health and healthcare for pregnant women and children.
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Affiliation(s)
- Vincent W V Jaddoe
- The Generation R Study Group, Erasmus Medical Center, Rotterdam, The Netherlands.
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17
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Jaddoe VWV, van Duijn CM, Franco OH, van der Heijden AJ, van IIzendoorn MH, de Jongste JC, van der Lugt A, Mackenbach JP, Moll HA, Raat H, Rivadeneira F, Steegers EAP, Tiemeier H, Uitterlinden AG, Verhulst FC, Hofman A. The Generation R Study: design and cohort update 2012. Eur J Epidemiol 2012; 27:739-56. [DOI: 10.1007/s10654-012-9735-1] [Citation(s) in RCA: 423] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Accepted: 09/20/2012] [Indexed: 12/11/2022]
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18
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Johansson B, Helgesson M, Lundberg I, Nordquist T, Leijon O, Lindberg P, Vingård E. Work and health among immigrants and native Swedes 1990-2008: a register-based study on hospitalization for common potentially work-related disorders, disability pension and mortality. BMC Public Health 2012; 12:845. [PMID: 23039821 PMCID: PMC3532317 DOI: 10.1186/1471-2458-12-845] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Accepted: 09/27/2012] [Indexed: 12/26/2022] Open
Abstract
Background There are many immigrants in the Swedish workforce, but knowledge of their general and work-related health is limited. The aim of this register-based study was to explore whether documented migrant residents in Sweden have a different health status regarding receipt of a disability pension, mortality and hospitalization for lung, heart, psychiatric, and musculoskeletal disorders compared with the native population, and if there were variations in relation to sex, geographical origin, position on the labor market, and time since first immigration. Methods This study included migrants to Sweden since 1960 who were 28–47 years old in 1990, and included 243 860 individuals. The comparison group comprised a random sample of 859 653 native Swedes. These cohorts were followed from 1991 to 2008 in national registers. The immigrants were divided into four groups based on geographic origin. Hazard ratios for men and women from different geographic origins and with different employment status were analyzed separately for the six outcomes, with adjustment for age, education level, and income. The influence of length of residence in Sweden was analyzed separately. Results Nordic immigrants had increased risks for all investigated outcomes while most other groups had equal or lower risks for those outcomes than the Swedes. The lowest HRs were found in the EU 15+ group (from western Europe, North America, Australia and New Zealand). All groups, except Nordic immigrants, had lower risk of mortality, but all had higher risk of disability pension receipt compared with native Swedes. Unemployed non-Nordic men displayed equal or lower HRs for most outcomes, except disability pension receipt, compared with unemployed Swedish men. A longer time since first immigration improved the health status of men, while women showed opposite results. Conclusions Employment status and length of residence are important factors for health. The contradictory results of low mortality and high disability pension risks need more attention. There is great potential to increase the knowledge in this field in Sweden, because of the high quality registers.
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Affiliation(s)
- Bo Johansson
- Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala, Sweden.
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19
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Hawkins NM, Jhund PS, McMurray JJV, Capewell S. Heart failure and socioeconomic status: accumulating evidence of inequality. Eur J Heart Fail 2012; 14:138-46. [PMID: 22253454 DOI: 10.1093/eurjhf/hfr168] [Citation(s) in RCA: 196] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS Socioeconomic status (SES) is a powerful predictor of incident coronary disease and adverse cardiovascular outcomes. Understanding the impact of SES on heart failure (HF) development and subsequent outcomes may help to develop effective and equitable prevention, detection, and treatment strategies METHODS AND RESULTS A systematic literature review of electronic databases including PubMed, EMBASE, CINAHL, and the Cochrane Library, restricted to human subjects, was carried out. The principal outcomes were incidence, prevalence, hospitalizations, mortality, and treatment of HF. Socioeconomic measures included education, occupation, employment relations, social class, income, housing characteristics, and composite and area level indicators. Additional studies were identified from bibliographies of relevant articles and reviews. Twenty-eight studies were identified. Lower SES was associated with increased incidence of HF, either in the community or presenting to hospital. The adjusted risk of developing HF was increased by ∼30-50% in most reports. Readmission rates following hospitalization were likewise greater in more deprived patients. Although fewer studies examined mortality, lower SES was associated with poorer survival. Evidence defining the equity of medical treatment of patients with HF was scarce and conflicting. CONCLUSIONS Socioeconomic deprivation is a powerful independent predictor of HF development and adverse outcomes. However, the precise mechanisms accounting for this risk remain elusive. Heart failure represents the endpoint of numerous different pathophysiological processes and 'chains of events', each modifiable throughout the disease trajectories. The interaction between SES and HF is accordingly complex. Disentangling the many and varied life course processes is challenging. A better understanding of these issues may help attenuate the health inequalities so clearly evident among patients with HF.
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Affiliation(s)
- Nathaniel M Hawkins
- Institute of Cardiovascular Medicine & Science, Liverpool Heart and Chest Hospital, Liverpool L14 3PE, UK.
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20
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Borné Y, Engström G, Essén B, Hedblad B. Immigrant status and increased risk of heart failure: the role of hypertension and life-style risk factors. BMC Cardiovasc Disord 2012; 12:20. [PMID: 22443268 PMCID: PMC3325899 DOI: 10.1186/1471-2261-12-20] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Accepted: 03/26/2012] [Indexed: 11/16/2022] Open
Abstract
Background Studies from Sweden have reported association between immigrant status and incidence of cardiovascular diseases. The nature of this relationship is unclear. We investigated the relationship between immigrant status and risk of heart failure (HF) hospitalization in a population-based cohort, and to what extent this is mediated by hypertension and life-style risk factors. We also explored whether immigrant status was related to case-fatality after HF. Methods 26,559 subjects without history of myocardial infarction (MI), stroke or HF from the community-based Malmö Diet and Cancer (MDC) cohort underwent a baseline examination during 1991-1996. Incidence of HF hospitalizations was monitored during a mean follow-up of 15 years. Results 3,129 (11.8%) subjects were born outside Sweden. During follow-up, 764 subjects were hospitalized with HF as primary diagnosis, of whom 166 had an MI before or concurrent with the HF. After adjustment for potential confounding factors, the hazard ratios (HR) for foreign-born were 1.37 (95% CI: 1.08-1.73, p = 0.009) compared to native Swedes, for HF without previous MI. The results were similar in a secondary analysis without censoring at incident MI. There was a significant interaction (p < 0.001) between immigrant status and waist circumference (WC), and the increased HF risk was limited to immigrants with high WC. Although not significant foreign-born tended to have lower one-month and one-year mortality after HF. Conclusions Immigrant status was associated with long-term risk of HF hospitalization, independently of hypertension and several life-style risk factors. A significant interaction between WC and immigrant status on incident HF was observed.
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Affiliation(s)
- Yan Borné
- Department of Clinical Sciences, Cardiovascular Epidemiology, Skåne University Hospital, Lund University, Malmö, Sweden.
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21
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Leening MJG, Kavousi M, Heeringa J, van Rooij FJA, Verkroost-van Heemst J, Deckers JW, Mattace-Raso FUS, Ziere G, Hofman A, Stricker BHC, Witteman JCM. Methods of data collection and definitions of cardiac outcomes in the Rotterdam Study. Eur J Epidemiol 2012; 27:173-85. [PMID: 22388767 PMCID: PMC3319884 DOI: 10.1007/s10654-012-9668-8] [Citation(s) in RCA: 180] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Accepted: 02/17/2012] [Indexed: 02/07/2023]
Abstract
The prevalence of cardiovascular diseases is rising. Therefore, adequate risk prediction and identification of its determinants is increasingly important. The Rotterdam Study is a prospective population-based cohort study ongoing since 1990 in the city of Rotterdam, The Netherlands. One of the main targets of the Rotterdam Study is to identify the determinants and prognosis of cardiovascular diseases. Case finding in epidemiological studies is strongly depending on various sources of follow-up and clear outcome definitions. The sources used for collection of data in the Rotterdam Study are diverse and the definitions of outcomes in the Rotterdam Study have changed due to the introduction of novel diagnostics and therapeutic interventions. This article gives the methods for data collection and the up-to-date definitions of the cardiac outcomes based on international guidelines, including the recently adopted cardiovascular disease mortality definitions. In all, detailed description of cardiac outcome definitions enhances the possibility to make comparisons with other studies in the field of cardiovascular research and may increase the strength of collaborations.
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Affiliation(s)
- Maarten J G Leening
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
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Abstract
Previous studies have suggested that asthma, like other common diseases, has at least part of its origin early in life. Low birth weight has been shown to be associated with increased risks of asthma, chronic obstructive airway disease, and impaired lung function in adults, and increased risks of respiratory symptoms in early childhood. The developmental plasticity hypothesis suggests that the associations between low birth weight and diseases in later life are explained by adaptation mechanisms in fetal life and infancy in response to various adverse exposures. Various pathways leading from adverse fetal and infant exposures to growth adaptations and respiratory health outcomes have been studied, including fetal and early infant growth patterns, maternal smoking and diet, children's diet, respiratory tract infections and acetaminophen use, and genetic susceptibility. Still, the specific adverse exposures in fetal and early postnatal life leading to respiratory disease in adult life are not yet fully understood. Current studies suggest that both environmental and genetic factors in various periods of life, and their epigenetic mechanisms may underlie the complex associations of low birth weight with respiratory disease in later life. New well-designed epidemiological studies are needed to identify the specific underlying mechanisms. This review is focused on specific adverse fetal and infant growth patterns and exposures, genetic susceptibility, possible respiratory adaptations and perspectives for new studies.
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Affiliation(s)
- Liesbeth Duijts
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.
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