Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Department of Epidemiology, Emory University, Atlanta, Georgia, USA.
Heart. 2020 Nov;106(21):1679-1685. doi: 10.1136/heartjnl-2019-316065. Epub 2020 Mar 6.
Social determinants of health are relevant to cardiovascular outcomes but have had limited examination in atrial fibrillation (AF).
The purpose of this study was to examine the association of annual household income and cardiovascular outcomes in individuals with AF.
We analysed administrative claims for individuals with AF from 2009 to 2015 captured by a health claims database. We categorised estimates of annual household income as <$40 000; $40-$59 999; $60-$74 999; $75-$99 999; and ≥$100 000. Covariates included demographics, education, cardiovascular disease risk factors, comorbid conditions and anticoagulation. We examined event rates by income category and in multivariable-adjusted models in reference to the highest income category (≥$100 000).
Our analysis included 336 736 individuals (age 72.7±11.9 years; 44.5% women; 82.6% white, 8.4% black, 7.0% Hispanic and 2.1% Asian) with AF followed for median (25th and 75th percentile) of 1.5 (95% CI 0.6 to 3.0) years. We observed an inverse association between income and heart failure and myocardial infarction (MI) with evidence of progressive risk across decreased income categories. Individuals with household income <$40 000 had the greatest risk for heart failure (HR 1.17; 95% CI 1.05 to 1.30) and MI (HR 1.18; 95% CI 0.98 to 1.41) compared with those with income ≥$100 000.
We identified an association between lower household income and adverse outcomes in a large cohort of individuals with AF. Our findings support consideration of income in the evaluation of cardiovascular risk in individuals with AF.
社会决定因素与心血管结局相关，但在心房颤动（AF）中研究有限。
本研究旨在探讨 AF 患者的年收入与心血管结局的关系。
我们分析了 2009 年至 2015 年期间健康索赔数据库中捕获的 AF 患者的行政索赔。我们将年收入估计值分为<$40000;$40-59999;$60-74999;$75-99999;和≥$100000。协变量包括人口统计学、教育、心血管疾病危险因素、合并症和抗凝治疗。我们根据最高收入类别（≥$100000），在收入类别和多变量调整模型中检查事件发生率。
我们的分析包括 336736 名年龄为 72.7±11.9 岁的 AF 患者（44.5%为女性；82.6%为白人，8.4%为黑人，7.0%为西班牙裔，2.1%为亚裔），中位随访时间为 1.5 年（95%CI 0.6 至 3.0）。我们观察到收入与心力衰竭和心肌梗死（MI）之间存在反比关系，随着收入水平的降低，风险逐渐增加。家庭收入<$40000 的患者心力衰竭（HR 1.17;95%CI 1.05 至 1.30）和 MI（HR 1.18;95%CI 0.98 至 1.41）的风险最高，与收入≥$100000 的患者相比。
我们在一个大型 AF 患者队列中发现了家庭收入较低与不良结局之间的关联。我们的发现支持在评估 AF 患者的心血管风险时考虑收入。
