International Journal of Health Policy and Management

International Journal of Health Policy and Management

Impact of Socio-Economic Status on the Hospital Readmission of Congestive Heart Failure Patients: A Prospective Cohort Study

Document Type : Original Article

Authors
Atefeh Noori 1, 2
Mostafa Shokoohi 3, 1
Mohammad Reza Baneshi 1
Nasim Naderi 4
Hooman Bakhshandeh 5
Ali Akbar Haghdoost 3, 1
1 Research Centre for Modelling in Health, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
2 Non-Communicable Diseases Research Center, Endocrinology and Metabolism population sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
3 Regional Knowledge Hub, and WHO Collaborating Centre for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
4 Cardiac Electrophysiology Research Center, Rajaee Cardiovascular Medical and Research Center, Tehran University of Medical Sciences, Tehran, Iran
5 Cardiac Intervention Research Center, Rajaee Cardiovascular, Medical and Research Center, Tehran University of Medical Sciences, Tehran, Iran
10.15171/ijhpm.2014.94
Abstract
Background
The aim of this study was to examine the impacts of multiple indicators of Socio-economic Status (SES) on Congestive Heart Failure (CHF) related readmission.
 
Methods
A prospective study consisting of 315 patients without the history of admission due to CHF was carried out in Tehran during 2010 and 2011. They were classified into quartiles based on their SES applying Principal Component Analysis (PCA), and followed up for one year. Using stratified Cox regression analysis, Hazard Ratios (HRs) were computed to assess the impact of SES on the readmission due to CHF.
 
Results
During the 12 months follow-up, 122 (40%) were readmitted at least once. HR of lowest SES patients vs. the highest SES patients (the fourth versus first quartile) was 2.66 (95% CI= 1.51–4.66). Variables including abnormal ejection fraction (<40%), poor physical activity, poor drug adherence, and hypertension were also identified as significant independent predictors of readmission.
 
Conclusion
The results showed low SES is a significant contributing factor to increased readmission due to CHF. It seems that the outcome of CHF depends on the SES of patients even after adjusting for some of main intermediate factors.
Keywords
Iran
Re-Hospitalization
Congestive Heart Failure
Socio-Economic Status (SES)
Equity
Factor Analysis
Subjects
  1. Ho KKL, Pinsky JL, Kannel WB, Levy D. The epidemiology of heart failure: the Framingham Study. J Am Coll Cardiol 1993; 22: A6-13.  doi: 10.1016/0735-1097(93)90455-a
  2. Philbin EF, Rocco TA, Lindenmuth NW, Ulrich K, Jenkins PL. Clinical outcomes in heart failure: report from a community hospital-based registry. Am J Med 1999; 107: 549-55. doi: 10.1016/s0002-9343(99)00309-5
  3. Berry C, Murdoch DR, McMurray JJ. Economics of chronic heart failure. Eur J Heart Fail2001; 3: 283-91. doi: 10.1016/s1388-9842(01)00123-4
  4. Cowie M, Fox K, Wood D, Metcalfe C, Thompson S, Coats A, et al. Hospitalization of patients with heart failure. A population-based study. Eur Heart J 2002; 23: 877.  doi: 10.1053/euhj.2001.2973
  5. Sarraf-Zadegan N1, Boshtam M, Malekafzali H, Bashardoost N, Sayed-Tabatabaei FA, Rafiei M, et al. Secular trends in cardiovascular mortality in Iran, with special reference to Isfahan. Acta Cardiol 1999; 54: 327-33. 
  6. Adler NE, Newman K. Socioeconomic disparities in health: pathways and policies. Health Aff 2002; 21: 60-76.  doi: 10.1377/hlthaff.21.2.60
  7. Bahonar A, Sarrafzadegan N, Kelishadi R, Shirani S, Ramezani MA, Taghdisi MH, et al. Association of socioeconomic profiles with cardiovascular risk factors in Iran: the Isfahan Healthy Heart Program. Int J Public Health 2011; 56: 37-44.  doi: 10.1007/s00038-010-0125-8
  8. Galobardes B, Lynch J, Smith GD. Measuring socioeconomic position in health research. Br Med Bull 2007; 81: 21-37.  doi: 10.1093/bmb/ldm001
  9. Islami F, Kamangar F, Nasrollahzadeh D, Aghcheli K, Sotoudeh M, Abedi-Ardekani B, et al. Socio-economic status and oesophageal cancer: results from a population-based case-control study in a high-risk area. Int J Epidemiol 2009; 38: 978-88.  doi: 10.1093/ije/dyp195
  10. Heart Failure Society Of America. Executive summary: HFSA 2006 comprehensive heart failure practice guideline. J Card Fail Feb 2006; 12: 10-38.  doi: 10.1016/j.cardfail.2005.12.001
  11. Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, et al. Recommendations for chamber quantification. Eur J Echocardiogr 2006; 7: 79-108.  doi: 10.1016/j.euje.2005.12.014
  12. Krumholz HM, Parent EM, Tu N, Vaccarino V, Wang Y, Radford MJ, et al. Readmission after hospitalization for congestive heart failure among Medicare beneficiaries. Arch Intern Med 1997; 157: 99.  doi: 10.1001/archinte.1997.00440220103013
  13. Haldeman GA, Croft JB, Giles WH, Rashidee A. Hospitalization of patients with heart failure: national hospital discharge survey 1985–1995. Am Heart J 1999; 137: 352–60.  doi: 10.1053/hj.1999.v137.95495
  14. Heo S, Lennie TA, Okoli C, Moser DK. Quality of life in patients with heart failure: ask the patients. Heart Lung 2009; 38: 100-8. doi: 10.1016/j.hrtlng.2008.04.002
  15. Philbin EF, Dec GW, Jenkins PL, DiSalvo TG. Socioeconomic status as an independent risk factor for hospital readmission for heart failure. Am J Cardiol 2001; 87: 1367-71. doi: 10.1016/s0002-9149(01)01554-5
  16. Skodova Z, Nagyova I, van Dijk JP, Sudzinova A, Vargova H, Rosenberger J, et al. Socioeconomic inequalities in quality of life and psychological outcomes among cardiac patients. Int J Public Health 2009; 54: 233-40.  doi: 10.1007/s00038-009-7086-9
  17. Rosen RC, Contrada RJ, Gorkin L, Kostis JB. Determinants of perceived health in patients with left ventricular dysfunction: a structural modeling analysis. Psychosom Med 1997; 59: 193-200.  doi: 10.1097/00006842-199703000-00012
  18. Pell JP, Pell ACH, Norrie J, Ford I, Cobbe SM. Effect of socioeconomic deprivation on waiting time for cardiac surgery: retrospective cohort study. BMJ 2000; 320: 15-9.  doi: 10.1136/bmj.320.7226.15
  19. Colhoun HM, Hemingway H, Poulter NR. Socio-economic status and blood pressure: an overview analysis. J Hum Hypertens 1998; 12: 91-110. doi: 10.1038/sj.jhh.1000558
  20. Struthers AD, Anderson G, Donnan PT, Macdonald T. Social deprivation increases cardiac hospitalizations in chronic heart failure independent of disease severity and diuretic non adherence. Heart 2000; 83: 12-6.  doi: 10.1136/heart.83.1.12
  21. Lewis G, Bebbington P, Brugha T. Socioeconomic status, standard of living and neurotic disorder. Lancet 1998; 352: 605-9. doi: 10.1016/s0140-6736(98)04494-8  
  22. Roos E, Lahelma E, Virtanen M, Prattala R, Pietinen P. Gender, socioeconomic status and family status as determinants of food behaviour. Soc Sci Med 1998; 46: 1519-29.  doi: 10.1016/s0140-6736(98)04494-8
  23. Rambod M, Peyravi H, Shokrpour N, Sareban MT. Dietary and fluid adherence in Iranian hemodialysis patients. Health Care Manag (Frederick) 2010; 29: 359-64.  doi: 10.1097/HCM.0b013e3181fa0691
  24. Tavasoli S, Heidarnazhad H, Kazemnejad A. Factors affecting patients' compliance to metered-dose inhaler drugs in two asthma clinics in Tehran, Iran. Iran J Allergy Asthma Immunol 2006; 5: 187-93. 
  25. Happ MB, Naylor MD, Roe Prior P. Factors contributing to rehospitalization of elderly patients with heart failure.  J Cardiovasc Nurs 1997; 11: 75–84. doi: 10.1097/00005082-199707000-00008
  26. Ghali JK, Kadakia S, Cooper R, Ferlinz J. Precipitating factors leading to decompensation of heart failure. Traits among urban blacks. Arch Intern Med 1988; 148: 2013-6.  doi: 10.1001/archinte.1988.00380090087021 
  27. Khalili H, Rohani R, Seyedalinaghi S, Hajiabdolbaghi M, Dashti-Khavidaki S, Talasaz AH. Adherence to antiretroviral therapy among Iranian HIV/AIDS patients. Curr Clin Pharmacol 2012; 7: 111-5.  doi: 10.2174/157488412800228910
  28. Guru V, Fremes SE, Austin PC, Blackstone EH, Tu JV. Gender differences in outcomes after hospital discharge from coronary artery bypass grafting. Circulation 2006; 113: 507-16.  doi: 10.1161/circulationaha.105.576652
  29. Galobardes B, Shaw M, Lawlor DA, Lynch JW, Davey Smith G. Indicators of socioeconomic position (part 1). J Epidemiol Community Health 2006; 60: 7-12.  doi: 10.1136/jech.2004.023531
  30. Winch C. The economic aims of education. J Philos Educ2002; 36: 101-17. 
  31. Geyer S, Hemstrom O, Peter R, Vagero D. Education, income, and occupational class cannot be used interchangeably in social epidemiology. Empirical evidence against a common practice. J Epidemiol Community Health 2006; 60: 804-10.  doi: 10.1136/jech.2005.041319
  32. Howe LD, Galobardes B, Matijasevich A, Gordon D, Johnston D, Onwujekwe O, et al. Measuring socio-economic position for epidemiological studies in low- and middle-income countries: a methods of measurement in epidemiology paper. Int J Epidemiol 2012; 41: 871-86.  doi: 10.1093/ije/dys037
  33. Galobardes B, Morabia A, Bernstein MS. Diet and socioeconomic position: does the use of different indicators matter? Int J Epidemiol 2001; 30: 334-40.  doi: 10.1093/ije/30.2.334
  34. Braveman PA, Cubbin C, Egerter S, Chideya S, Marchi KS, Metzler M, et al. Socioeconomic status in health research: one size does not fit all. JAMA 2005; 294: 2879-88.  doi: 10.1001/jama.294.22.2879
  35. Pollack CE, Chideya S, Cubbin C, Williams B, Dekker M, Braveman P. Should health studies measure wealth? A systematic review. Am J Prev Med 2007; 33: 250-64. doi: 10.1016/j.amepre.2007.04.033  

 

  • Received Date 25 May 2014
  • Revised Date 12 September 2014
  • Accepted Date 25 September 2014
  • First Published Date 01 October 2014
  • Published Date 01 October 2014