British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom.
British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom; Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark.
JACC Heart Fail. 2019 Apr;7(4):336-346. doi: 10.1016/j.jchf.2018.11.005. Epub 2019 Feb 6.
This study examined the relationship between income inequality and heart failure outcomes.
The income inequality hypothesis postulates that population health is influenced by income distribution within a society, with greater inequality associated with worse outcomes.
This study analyzed heart failure outcomes in 2 large trials conducted in 54 countries. Countries were divided by tertiles of Gini coefficients (where 0% represented absolute income equality and 100% represented absolute income inequality), and heart failure outcomes were adjusted for standard prognostic variables, country per capita income, education index, hospital bed density, and health worker density.
Of the 15,126 patients studied, 5,320 patients lived in Gini coefficient tertile 1 countries (coefficient: <33%), 6,124 patients lived in tertile 2 countries (33% to 41%), and 3,772 patients lived in tertile 3 countries (>41%). Patients in tertile 3 were younger than tertile 1 patients, were more often women, and had less comorbidity and several indicators of less severe heart failure, yet the tertile 3-to-1 hazard ratios (HRs) for the primary composite outcome of cardiovascular death or heart failure hospitalization were 1.57 (95% confidence interval [CI]: 1.38 to 1.79) and 1.48 for all-cause death (95% CI: 1.29 to 1.71) after adjustment for recognized prognostic variables. After additional adjustments were made for per capita income, education index, hospital bed density, and health worker density, these HRs were 1.46 (95% CI: 1.25 to 1.70) and 1.30 (95% CI: 1.10 to 1.53), respectively.
Greater income inequality was associated with worse heart failure outcomes, with an impact similar to those of major comorbidities. Better understanding of the societal and personal bases of these findings may suggest approaches to improve heart failure outcomes.
本研究旨在探讨收入不平等与心力衰竭结局之间的关系。
收入不平等假说认为，人口健康受到社会内部收入分配的影响，不平等程度越高，结局越差。
本研究分析了在 54 个国家进行的 2 项大型试验中的心力衰竭结局。各国按基尼系数的三分位数（0%代表绝对收入平等，100%代表绝对收入不平等）进行分组，并用标准预后变量、国家人均收入、教育指数、病床密度和卫生工作者密度对心力衰竭结局进行调整。
在纳入的 15126 例患者中，5320 例患者生活在基尼系数三分位数 1 国家（系数：<33%），6124 例患者生活在三分位数 2 国家（33%41%），3772 例患者生活在三分位数 3 国家（>41%）。三分位数 3 的患者比三分位数 1 的患者更年轻，更多为女性，且合并症较少，心力衰竭严重程度的几项指标也较低，但在调整了公认的预后变量后，主要复合结局（心血管死亡或心力衰竭住院）的三分位数 3 与三分位数 1 的风险比（HR）为 1.57（95%置信区间[CI]：1.381.79），全因死亡的 HR 为 1.48（95% CI：1.291.71）。在进一步按人均收入、教育指数、病床密度和卫生工作者密度调整后，这些 HR 分别为 1.46（95% CI：1.251.70）和 1.30（95% CI：1.10~1.53）。
收入不平等程度越高，心力衰竭结局越差，其影响与主要合并症相似。更好地了解这些发现的社会和个人基础，可能有助于提出改善心力衰竭结局的方法。
