Neighbourhood socio-economic status and all-cause mortality in adults with atrial fibrillation: A cohort study of patients treated in primary care in Sweden

INTERNATIONAL JOURNAL OF CARDIOLOGY

卷:202

Article

Wandell, Per^1,2  Carlsson, Axel C.^1,3  Gasevic, Danijela⁴  Sundquist, Jan⁵  Sundquist, Kristina⁵ 

[1] Karolinska Inst, Div Family Med, Dept Neurobiol Care Sci & Soc, S-14183 Huddinge, Sweden

[2] Stockholm Cty Council, Acad Primary Healthcare Ctr, Huddinge, Sweden

[3] Uppsala Univ, Dept Med Sci, Cardiovasc Epidemiol, Uppsala, Sweden

[4] Univ Edinburgh, Coll Med & Vet Med, Ctr Populat Hlth Sci, Edinburgh, Midlothian, Scotland

[5] Lund Univ, Ctr Primary Hlth Care Res, Malmo, Sweden

关键词: Neighbourhood;    Atrial fibrillation;    Mortality;    Gender;    Follow-up;    Co-morbidity;    Antithrombotic drugs;   

DOI  :  10.1016/j.ijcard.2015.09.027

来源: Elsevier

【 摘 要 】

Objective: Our aim was to study the potential impact of neighbourhood socio-economic status (SES) on all-cause mortality in patients with atrial fibrillation (AF) treated in primary care. Methods: Study population included adults (n = 12,283) of 45 years and older diagnosed with AF in 75 primary care centres in Sweden. Association between neighbourhood SES and all-cause mortality was explored using Cox regression analysis, with hazard ratios (HRs) and 95% confidence intervals (95% CIs), and by Laplace regression where years to death (95% CI) of the first 10% of the participants were used as an outcome. All models were conducted in both men and women and adjusted for age, educational level, marital status, change of neighbourhood status, cardiovascular co-morbidities, anticoagulant treatment and statin treatment. High-and low neighbourhood SES were compared with middle SES as reference group. Results: After adjustments for potential confounders, higher relative risk of all-cause mortality (HR 1.49, 95% CI 1.13-1.96) was observed in men living in low SES neighbourhoods compared to those from middle SES neighbourhoods. The results were confirmed using Laplace regression; the time until the first 10% of the men in low SES neighbourhoods died was 1.45 (95% CI 0.48-2.42) years shorter than for the men in middle SES neighbourhoods. Conclusions: Increased rates of heart disease and subsequent mortality among adults in deprived neighbourhoods raise important clinical and public health concerns. These findings could serve as an aid to policy-makers when allocating resources in primary health care settings as well as to clinicians who encounter patients in deprived neighbourhoods. (C) 2015 Elsevier Ireland Ltd. All rights reserved.

【 授权许可】

Free