Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
Departments of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Aalborg, Denmark.
Eur J Heart Fail. 2018 Feb;20(2):240-247. doi: 10.1002/ejhf.1046. Epub 2017 Nov 16.
Employment status at time of first heart failure (HF) hospitalization may be an indicator of both self-perceived and objective health status. In this study, we examined the association between employment status and the risk of all-cause mortality and recurrent HF hospitalization in a nationwide cohort of patients with HF.
We identified all patients of working age (18-60 years) with a first HF hospitalization in the period 1997-2015 in Denmark, categorized according to whether or not they were part of the workforce at time of the index admission. The primary outcome was death from any cause and the secondary outcome was readmission for HF. Cumulative incidence curves, binomial regression and Cox regression models were used to assess outcomes. Of 25 571 patients with a first hospitalization for HF, 15 428 (60%) were part of the workforce at baseline. Patients in the workforce were significantly younger (53 vs. 55 years) more likely to be male (75% vs 64%) and less likely to have diabetes (13% vs 22%) and chronic obstructive pulmonary disease (5% vs 10%) (all P < 0.0001). Not being part of the workforce was associated with a significantly higher risk of death [hazard ratio (HR) 1.59; 95% confidence interval (CI) 1.50-1.68] and rehospitalization for HF (HR 1.09; 95% CI 1.05-1.14), in analyses adjusted for age, sex, co-morbidities, education level, calendar time, and duration of first HF hospitalization.
Not being part of the workforce at time of first HF hospitalization was independently associated with increased mortality and recurrent HF hospitalization.
首次心力衰竭（HF）住院时的就业状况可能是自我感知和客观健康状况的指标。在这项研究中，我们在丹麦的全国性 HF 患者队列中研究了就业状况与全因死亡率和 HF 再住院风险之间的关系。
我们确定了 1997 年至 2015 年期间在丹麦首次因 HF 住院的所有工作年龄（18-60 岁）患者，根据他们在入院时是否属于劳动力人群进行分类。主要结局是任何原因导致的死亡，次要结局是 HF 再入院。使用累积发病率曲线、二项回归和 Cox 回归模型来评估结局。在 25571 名首次因 HF 住院的患者中，有 15428 名（60%）在基线时属于劳动力人群。劳动力人群中的患者年龄明显更小（53 岁 vs. 55 岁），男性比例更高（75% vs. 64%），糖尿病（13% vs. 22%）和慢性阻塞性肺疾病（5% vs. 10%）的比例较低（均 P < 0.0001）。不参与劳动力与死亡风险显著增加相关（风险比 [HR] 1.59；95%置信区间 [CI] 1.50-1.68）和 HF 再住院风险（HR 1.09；95% CI 1.05-1.14），在调整年龄、性别、合并症、教育程度、日历时间和首次 HF 住院持续时间后进行分析。
首次 HF 住院时不属于劳动力人群与死亡率和 HF 再住院率增加独立相关。
