What is the clinical evidence from this study?

Study design: Cohort. Population: Heart failure (n=15402). Intervention: Socioeconomic deprivation vs. Least deprived subjects. Primary outcome: Hospitalisation with a primary diagnosis of HF (RR 1.39, 95% CI 1.04-2.01, p=0.04).

March 8, 2006Open Access

Effect of Socioeconomic Deprivation on the Population Risk of Incident Heart Failure Hospitalisation: An Analysis of the Renfrew/Paisley Study

Key Result

Greater socioeconomic deprivation increased the risk of incident heart failure hospitalization over 20 years compared to the least deprived subjects (RR 1.39; 95% CI 1.04-2.01; P=0.04).

Study Design

Type

Cohort (n=15,402)

Multicenter

Yes

Structured PICO

Does socioeconomic deprivation increase the risk of incident heart failure hospitalisation in adults aged 45-64 years?

Population

15,402 individuals aged 45-64 years from two Scottish towns, followed for 20 years to assess incident heart failure hospitalisation.

Exposure

Socioeconomic deprivation (assessed by Carstairs deprivation category and Social Class)

Comparator

Least deprived subjects (most affluent group)

Outcome

Hospitalisation with a primary diagnosis of heart failure over 20 yearshard clinical

Socioeconomic deprivation is independently associated with an increased risk of incident heart failure hospitalization over a 20-year period, irrespective of baseline cardio-respiratory status.

Main Result

Relative Risk: 1.39 (95% CI 1.04–2.01)

Absolute Event Rate: 6.4% vs 3.5%

p-value: p=0.04

Abstract

BACKGROUND: There are few data describing the effect of socioeconomic deprivation on the risk of developing heart failure (HF). AIMS: To examine the relationship between socioeconomic deprivation and hospitalisation with HF over 20 years. METHODS: Between 1972 and 1976, 15,402 individuals, aged 45-64 years, residing in two towns in Scotland, underwent cardiovascular screening. We report hospitalisations with HF over the subsequent 20 years according to Carstairs deprivation category and Social Class. RESULTS: Following screening, 628 men and women (4.1%) were hospitalised with a primary diagnosis of HF. There was a gradient in the risk of HF hospitalisation with increasing socioeconomic deprivation (P=0.003). Of the most deprived individuals, 6.4% were hospitalised for HF compared to 3.5% of the most affluent group. Cox-proportional Hazard models showed that independent of age, sex and baseline risk factors for cardio-respiratory status, greater socioeconomic deprivation increased the risk of HF admission (P<0.001, overall). The adjusted risk of admission for HF was 39% greater in the most versus least deprived subjects (RR 1.39 95% CI 1.04-2.01; P=0.04). CONCLUSION: These data show a link between social deprivation and the risk of developing HF, irrespective of baseline cardio-respiratory status and cardiovascular risk factors.