The mediating role of effective treatments in the relationship between income level and survival in patients with heart failure: a sex- and cohabitation-stratified study

Research output: Contribution to journalJournal articlepeer-review

Standard

The mediating role of effective treatments in the relationship between income level and survival in patients with heart failure : a sex- and cohabitation-stratified study. / Andersen, Julie; Gerds, Thomas A.; Hlatky, Mark A.; Gislason, Gunnar; Schou, Morten; Torp-Pedersen, Christian; Møller, Sidsel; Madelaire, Christian; Strandberg-Larsen, Katrine.

In: European Journal of Preventive Cardiology, Vol. 28, No. 1, 2021, p. 78-86.

Research output: Contribution to journalJournal articlepeer-review

Harvard

Andersen, J, Gerds, TA, Hlatky, MA, Gislason, G, Schou, M, Torp-Pedersen, C, Møller, S, Madelaire, C & Strandberg-Larsen, K 2021, 'The mediating role of effective treatments in the relationship between income level and survival in patients with heart failure: a sex- and cohabitation-stratified study', European Journal of Preventive Cardiology, vol. 28, no. 1, pp. 78-86. https://doi.org/10.1093/eurjpc/zwaa005

APA

Andersen, J., Gerds, T. A., Hlatky, M. A., Gislason, G., Schou, M., Torp-Pedersen, C., Møller, S., Madelaire, C., & Strandberg-Larsen, K. (2021). The mediating role of effective treatments in the relationship between income level and survival in patients with heart failure: a sex- and cohabitation-stratified study. European Journal of Preventive Cardiology, 28(1), 78-86. https://doi.org/10.1093/eurjpc/zwaa005

Vancouver

Andersen J, Gerds TA, Hlatky MA, Gislason G, Schou M, Torp-Pedersen C et al. The mediating role of effective treatments in the relationship between income level and survival in patients with heart failure: a sex- and cohabitation-stratified study. European Journal of Preventive Cardiology. 2021;28(1):78-86. https://doi.org/10.1093/eurjpc/zwaa005

Author

Andersen, Julie ; Gerds, Thomas A. ; Hlatky, Mark A. ; Gislason, Gunnar ; Schou, Morten ; Torp-Pedersen, Christian ; Møller, Sidsel ; Madelaire, Christian ; Strandberg-Larsen, Katrine. / The mediating role of effective treatments in the relationship between income level and survival in patients with heart failure : a sex- and cohabitation-stratified study. In: European Journal of Preventive Cardiology. 2021 ; Vol. 28, No. 1. pp. 78-86.

Bibtex

@article{8c6822d3cf1e40ee85ad7eb340518dee,
title = "The mediating role of effective treatments in the relationship between income level and survival in patients with heart failure: a sex- and cohabitation-stratified study",
abstract = "Aims Patients with heart failure and low income have a high mortality risk. We examined whether lower survival among low-income patients with heart failure could be explained by different use of beta-blockers, renin-angiotensin system inhibitors (RASi), and implanted devices compared with high-income patients.Methods and results We linked Danish national registries to identify patients with new-onset heart failure between 2005 and 2016. A total of 18 308 patients was included in the main analysis. We collected information on medical treatment and device therapy after discharge. We investigated the remaining income disparity if everybody had the same probability of treatment as the high-income patients. We used causal mediation analysis to examine to what extent treatment differences mediate the association between income and 1-year mortality in strata defined by sex and cohabitation status. If low-income patients had the same probability of initiating beta-blockers and RASi treatment as high-income patients, low-income men who lived alone would increase initiation of treatment by 12.4% (CI: 10.0% to 14.9%) and as a result reduce their absolute 1-year mortality by 1.0% (CI: -1.4% to -0.5%). If low-income patients had the same probability of not having breaks in medical treatment and getting device therapy, as high-income patients, low-income patients would increase the probability of not having breaks in treatment between 1.8% and 5.8% and increase the probability of getting device therapy between 1.0% and 3.8%, across strata of sex and cohabitation status.Conclusion Lower rates of treatment initiation appear to mediate the poorer survival seen among patients with heart failure and low income, but only in males living alone.",
keywords = "Heart failure, Mortality, Treatment, Income, HEALTH-CARE-SYSTEM, MEDICATION ADHERENCE, SOCIOECONOMIC DEPRIVATION, POPULATION, MORTALITY, RISK",
author = "Julie Andersen and Gerds, {Thomas A.} and Hlatky, {Mark A.} and Gunnar Gislason and Morten Schou and Christian Torp-Pedersen and Sidsel M{\o}ller and Christian Madelaire and Katrine Strandberg-Larsen",
year = "2021",
doi = "10.1093/eurjpc/zwaa005",
language = "English",
volume = "28",
pages = "78--86",
journal = "European Journal of Preventive Cardiology",
issn = "2047-4873",
publisher = "SAGE Publications",
number = "1",

}

RIS

TY - JOUR

T1 - The mediating role of effective treatments in the relationship between income level and survival in patients with heart failure

T2 - a sex- and cohabitation-stratified study

AU - Andersen, Julie

AU - Gerds, Thomas A.

AU - Hlatky, Mark A.

AU - Gislason, Gunnar

AU - Schou, Morten

AU - Torp-Pedersen, Christian

AU - Møller, Sidsel

AU - Madelaire, Christian

AU - Strandberg-Larsen, Katrine

PY - 2021

Y1 - 2021

N2 - Aims Patients with heart failure and low income have a high mortality risk. We examined whether lower survival among low-income patients with heart failure could be explained by different use of beta-blockers, renin-angiotensin system inhibitors (RASi), and implanted devices compared with high-income patients.Methods and results We linked Danish national registries to identify patients with new-onset heart failure between 2005 and 2016. A total of 18 308 patients was included in the main analysis. We collected information on medical treatment and device therapy after discharge. We investigated the remaining income disparity if everybody had the same probability of treatment as the high-income patients. We used causal mediation analysis to examine to what extent treatment differences mediate the association between income and 1-year mortality in strata defined by sex and cohabitation status. If low-income patients had the same probability of initiating beta-blockers and RASi treatment as high-income patients, low-income men who lived alone would increase initiation of treatment by 12.4% (CI: 10.0% to 14.9%) and as a result reduce their absolute 1-year mortality by 1.0% (CI: -1.4% to -0.5%). If low-income patients had the same probability of not having breaks in medical treatment and getting device therapy, as high-income patients, low-income patients would increase the probability of not having breaks in treatment between 1.8% and 5.8% and increase the probability of getting device therapy between 1.0% and 3.8%, across strata of sex and cohabitation status.Conclusion Lower rates of treatment initiation appear to mediate the poorer survival seen among patients with heart failure and low income, but only in males living alone.

AB - Aims Patients with heart failure and low income have a high mortality risk. We examined whether lower survival among low-income patients with heart failure could be explained by different use of beta-blockers, renin-angiotensin system inhibitors (RASi), and implanted devices compared with high-income patients.Methods and results We linked Danish national registries to identify patients with new-onset heart failure between 2005 and 2016. A total of 18 308 patients was included in the main analysis. We collected information on medical treatment and device therapy after discharge. We investigated the remaining income disparity if everybody had the same probability of treatment as the high-income patients. We used causal mediation analysis to examine to what extent treatment differences mediate the association between income and 1-year mortality in strata defined by sex and cohabitation status. If low-income patients had the same probability of initiating beta-blockers and RASi treatment as high-income patients, low-income men who lived alone would increase initiation of treatment by 12.4% (CI: 10.0% to 14.9%) and as a result reduce their absolute 1-year mortality by 1.0% (CI: -1.4% to -0.5%). If low-income patients had the same probability of not having breaks in medical treatment and getting device therapy, as high-income patients, low-income patients would increase the probability of not having breaks in treatment between 1.8% and 5.8% and increase the probability of getting device therapy between 1.0% and 3.8%, across strata of sex and cohabitation status.Conclusion Lower rates of treatment initiation appear to mediate the poorer survival seen among patients with heart failure and low income, but only in males living alone.

KW - Heart failure

KW - Mortality

KW - Treatment

KW - Income

KW - HEALTH-CARE-SYSTEM

KW - MEDICATION ADHERENCE

KW - SOCIOECONOMIC DEPRIVATION

KW - POPULATION

KW - MORTALITY

KW - RISK

U2 - 10.1093/eurjpc/zwaa005

DO - 10.1093/eurjpc/zwaa005

M3 - Journal article

C2 - 33623976

VL - 28

SP - 78

EP - 86

JO - European Journal of Preventive Cardiology

JF - European Journal of Preventive Cardiology

SN - 2047-4873

IS - 1

ER -

ID: 269793505