What is the clinical evidence from this study?

Study design: Cohort. Population: newly diagnosed hypertension (n=28306). Intervention: Low household income and disadvantaged neighborhood vs. High household income and advantaged neighborhood. Primary outcome: all-cause mortality (HR 1.35, 95% CI 1.22-1.49).

January 7, 2016Open Access

Disparities in socioeconomic status and neighborhood characteristics affect all-cause mortality in patients with newly diagnosed hypertension in Korea: a nationwide cohort study, 2002–2013

Key Result

Among patients with newly diagnosed hypertension, low household income combined with living in a disadvantaged neighborhood increased the risk of all-cause mortality compared to high income in an advantaged neighborhood (HR 1.35).

Study Design

Type

Cohort (n=28,306)

Structured PICO

Does neighborhood deprivation and individual socioeconomic status affect all-cause mortality in patients with newly diagnosed hypertension?

Population

28,306 adults aged 20 and older with newly diagnosed hypertension taking antihypertensive medication in South Korea, followed for 7 to 10 years.

Exposure

Disadvantaged neighborhood deprivation and low individual socioeconomic status (observational exposure)

Comparator

Advantaged neighborhood deprivation and high individual socioeconomic status

Outcome

All-cause mortalityhard clinical

Neighborhood deprivation exacerbates the influence of individual socioeconomic status on all-cause mortality among patients with newly diagnosed hypertension.

Main Result

Hazard Ratio: 1.35 (95% CI 1.22–1.49)

Limitations

Included only high risk groups with hypertension, limiting generalizability to the general population.
Could not consider factors such as lifestyle and education, which influence mortality risk, because these factors were not captured by the claims database.
Lacked detailed physiologic data such as blood pressure due to inability to perform actual chart review.
Did not consider changes in the neighborhood deprivation status for study participants who moved during the study period.

Abstract

BACKGROUND: Previous studies have shown that contextual factors and individual socioeconomic status (SES) were associated with mortality in Western developed countries. In Korea, there are few empirical studies that have evaluated the association between SES and health outcomes. METHODS: We conducted cohort study to investigate the socioeconomic disparity in all-cause mortality for patients newly diagnosed with hypertension in the setting of universal health care coverage. We used stratified random sample of Korean National Health Insurance enrollees (2002-2013). We included patients newly diagnosed with hypertension (n = 28,306) from 2003-2006, who received oral medication to control their hypertension. We generated a frailty model using Cox's proportional hazard regression to assess risk factors for mortality. RESULTS: A total of 7,825 (27.6%) of the 28,306 eligible subjects died during the study period. Compared to high income patients from advantaged neighborhoods, the adjusted hazard ratio (HR) for high income patients from disadvantaged neighborhoods was 1.10 (95% CI, 1.00-1.20; p-value = 0.05). The adjusted HR for middle income patients who lived in advantaged versus disadvantaged neighborhoods was 1.17 (95% CI, 1.08-1.26) and 1.27 (95% CI, 1.17-1.38), respectively. For low income patients, the adjusted HR for patients who lived in disadvantaged neighborhoods was higher than those who lived in advantaged neighborhoods (HR, 1.35; 95% CI, 1.22-1.49 vs HR, 1.28; 95% CI, 1.16-1.41). CONCLUSIONS: Neighborhood deprivation can exacerbate the influence of individual SES on all-cause mortality among patients with newly diagnosed hypertension.

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