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丹麦心脏移植受者个体社会经济地位与长期预后。

Individual-Level Socioeconomic Position and Long-Term Prognosis in Danish Heart-Transplant Recipients.

机构信息

Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.

Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.

出版信息

Transpl Int. 2023 Mar 22;36:10976. doi: 10.3389/ti.2023.10976. eCollection 2023.

Abstract

Socioeconomic deprivation can limit access to healthcare. Important gaps persist in the understanding of how individual indicators of socioeconomic disadvantage may affect clinical outcomes after heart transplantation. We sought to examine the impact of individual-level socioeconomic position (SEP) on prognosis of heart-transplant recipients A population-based study including all Danish first-time heart-transplant recipients ( = 649) was conducted. Data were linked across complete national health registers. Associations were evaluated between SEP and all-cause mortality and first-time major adverse cardiovascular event (MACE) during follow-up periods. The half-time survival was 15.6 years (20-year period). In total, 330 (51%) of recipients experienced a first-time cardiovascular event and the most frequent was graft failure (42%). Both acute myocardial infarction and cardiac arrest occurred in ≤5 of recipients. Low educational level was associated with increased all-cause mortality 10-20 years post-transplant (adjusted hazard ratio [HR] 1.95, 95% confidence interval [CI] 1.19-3.19). During 1-10 years post-transplant, low educational level (adjusted HR 1.66, 95% CI 1.14-2.43) and low income (adjusted HR 1.81, 95% CI 1.02-3.22) were associated with a first-time MACE. In a country with free access to multidisciplinary team management, low levels of education and income were associated with a poorer prognosis after heart transplantation.

摘要

社会经济贫困可能会限制获得医疗保健的机会。人们对于个体社会经济劣势指标如何影响心脏移植后的临床结果,仍存在重要的理解差距。我们旨在研究个体社会经济地位(SEP)对心脏移植受者预后的影响。进行了一项基于人群的研究,纳入了所有丹麦首次心脏移植受者(=649)。数据通过完整的国家健康登记进行了关联。评估了 SEP 与全因死亡率和随访期间首次主要不良心血管事件(MACE)之间的关联。半时生存率为 15.6 年(20 年期间)。共有 330 名(51%)受者经历了首次心血管事件,最常见的是移植物衰竭(42%)。急性心肌梗死和心脏骤停均发生在≤5 名受者中。低教育水平与移植后 10-20 年全因死亡率增加相关(调整后的危险比[HR]1.95,95%置信区间[CI]1.19-3.19)。在移植后 1-10 年期间,低教育水平(调整后的 HR 1.66,95%CI 1.14-2.43)和低收入(调整后的 HR 1.81,95%CI 1.02-3.22)与首次 MACE 相关。在一个享有多学科团队管理的免费准入的国家,低教育水平和低收入与心脏移植后的预后较差相关。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/af25/10073462/f3f11e3a1564/ti-36-10976-g001.jpg

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