Department of Health Sciences Research Mayo Clinic Rochester MN.
Division of Health Policy and Management University of Minnesota School of Public Health Minneapolis MN.
J Am Heart Assoc. 2021 Feb 16;10(4):e018026. doi: 10.1161/JAHA.120.018026. Epub 2021 Feb 3.
Background Prior reports indicate that living in a rural area may be associated with worse health outcomes. However, data on rurality and heart failure (HF) outcomes are scarce. Methods and Results Residents from 6 southeastern Minnesota counties with a first-ever code for HF ( [], code 428, and [] code I50) between January 1, 2013 and December 31, 2016, were identified. Resident address was classified according to the rural-urban commuting area codes. Rurality was defined as living in a nonmetropolitan area. Cox regression was used to analyze the association between living in a rural versus urban area and death; Andersen-Gill models were used for hospitalization and emergency department visits. Among 6003 patients with HF (mean age 74 years, 48% women), 43% lived in a rural area. Rural patients were older and had a lower educational attainment and less comorbidity compared with patients living in urban areas (<0.001). After a mean (SD) follow-up of 2.8 (1.7) years, 2440 deaths, 20 506 emergency department visits, and 11 311 hospitalizations occurred. After adjustment, rurality was independently associated with an increased risk of death (hazard ratio [HR], 1.18; 95% CI, 1.09-1.29) and a reduced risk of emergency department visits (HR, 0.89; 95% CI, 0.82-0.97) and hospitalizations (HR, 0.78; 95% CI, 0.73-0.84). Conclusions Among patients with HF, living in a rural area is associated with an increased risk of death and fewer emergency department visits and hospitalizations. Further study to identify and address the mechanisms through which rural residence influences mortality and healthcare utilization in HF is needed in order to reduce disparities in rural health.
先前的报告表明，居住在农村地区可能与较差的健康结果相关。然而，关于农村地区和心力衰竭（HF）结局的数据很少。
确定 2013 年 1 月 1 日至 2016 年 12 月 31 日期间，明尼苏达州东南部 6 个县首次出现心力衰竭（HF）代码（[]，代码 428 和 []，代码 I50）的居民。根据城乡通勤区代码对居民地址进行分类。农村性定义为居住在非城市地区。使用 Cox 回归分析居住在农村与城市地区与死亡之间的关系；使用 Andersen-Gill 模型分析住院和急诊就诊。在 6003 名 HF 患者（平均年龄 74 岁，48%为女性）中，43%居住在农村地区。与居住在城市地区的患者相比，农村患者年龄更大，教育程度更低，合并症更少（<0.001）。平均（SD）随访 2.8（1.7）年后，发生 2440 例死亡，20506 次急诊就诊和 11311 次住院治疗。调整后，农村性与死亡风险增加独立相关（风险比[HR]，1.18；95%可信区间，1.09-1.29），急诊就诊风险降低（HR，0.89；95%可信区间，0.82-0.97）和住院治疗（HR，0.78；95%可信区间，0.73-0.84）。
在 HF 患者中，居住在农村地区与死亡风险增加以及急诊就诊和住院治疗次数减少相关。需要进一步研究确定和解决农村居住影响 HF 患者死亡率和医疗保健利用的机制，以减少农村卫生方面的差异。
