Association of income and educational attainment in hospitalization events in atrial fibrillation.
Association of income and educational attainment in hospitalization events in atrial fibrillation.
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DOI：
10.1016/j.ajpc.2021.100201
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发表时间：
2021-09
影响因子：
4.1
通讯作者：
Magnani JW
中科院分区：
文献类型：
--
作者：
Tertulien T;Chen Y;Althouse AD;Essien UR;Johnson A;Magnani JW
对社会决定因素和心房颤动 (AF) 的调查有限。我们测量了 AF 患者队列 (n = 339) 的收入、教育程度和住院情况。社会决定因素与中位 2.6 年的住院事件相关。解决健康的社会决定因素可能会减少房颤的不良事件。社会决定因素会导致心血管和非心血管疾病的不良后果。然而，他们对心房颤动（AF）的研究仍然有限。我们研究了在地区医疗保健系统中接受护理的房颤患者的年收入和教育程度与住院风险之间的关系。我们假设收入较低和受教育程度较低的人住院的风险会增加。我们招募了一组来自流动环境的患有普遍房颤的个体。我们将年收入（≤19,999 美元/年；20,000–49,000 美元/年；50,000–99,999 美元/年；≥100,000 美元/年）和教育程度（高中/职业；一些大学；学士；研究生）与多变量调整的 Cox 比例风险模型中的住院事件相关联，使用 Andersen-Gill 模型来考虑参与者的潜力有多个事件。我们对 339 名 AF 患者（年龄 72.3 ± 10.1 岁；43% 女性）进行了中位 2.6 年（范围 0-3.4 年）的随访，观察到 417 起住院事件。我们发现收入和教育程度与住院风险之间存在关联。在包括教育程度最低年收入类别（≤19,999/年）的个体的多变量调整分析中，其住院风险是最高年收入类别（≥100,000/年；95% 置信区间 [CI] 1.08–4.09；p = 0.03）的 2.0 倍。在不调整收入的多变量调整分析中，教育程度最低的人（高中/职业教育）的住院风险相对于教育程度最高的人（研究生；95% CI 1.12-3.54，p = 0.02）增加了 2 倍。然而，教育与活动之间的这种关联随着收入的进一步调整而减弱（95% CI 0.97–3.15，p = 0.06）。我们确定了收入和教育程度以及房颤住院风险的预期风险之间的关系。我们的研究结果支持在评估和治疗患有 AF 的社会经济弱势个体时考虑社会决定因素，以降低住院风险。
Investigation of social determinants and atrial fibrillation (AF) is limited. We measured income, education, and hospitalizations in a cohort (n = 339) with AF. Social determinants were related to hospitalization events over median 2.6-years. Addressing social determinants of health may reduce adverse events in AF. Social determinants contribute to adverse outcomes in cardiovascular and non-cardiovascular conditions. However, their investigation in atrial fibrillation (AF) remains limited. We examined the associations between annual income and educational attainment with risk of hospitalization in individuals with AF receiving care in a regional health care system. We hypothesized that individuals with lower income and lower education would have an increased risk of hospitalization. We enrolled a cohort of individuals with prevalent AF from an ambulatory setting. We related annual income (≤$19,999/year; $20,000–49,000/year; $50,000–99,999/year; ≥$100,000/year) and educational attainment (high school/vocational; some college; Bachelor's; graduate) to hospitalization events in multivariable-adjusted Cox proportional hazards models, using the Andersen-Gill model to account for the potential of participants to have multiple events. In 339 individuals with AF (age 72.3 ± 10.1 years; 43% women) followed for median 2.6 years (range 0–3.4 years), we observed 417 hospitalization events. We identified an association between both income and educational attainment and hospitalization risk. In multivariable-adjusted analyses which included educational attainment individuals in the lowest annual income category (≤19,999/year) had 2.0-fold greater hospitalization risk than those in the highest (≥100,000/year; 95% Confidence Interval [CI] 1.08–4.09; p = 0.03). In multivariable-adjusted analyses without adjustment for income, those in the lowest educational attainment category (high school/vocational) had a 2-fold increased risk of hospitalization relative to the highest (graduate-level; 95% CI 1.12–3.54, p = 0.02). However, this association between education and events was attenuated with further adjustment for income (95% CI 0.97–3.15, p = 0.06). We identified relationships between income and education and prospective risk of hospitalization risk in AF. Our findings support the consideration of social determinants in evaluating and treating socioeconomically disadvantaged individuals with AF to reduce hospitalization risk.
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