Brown O I, Drozd M, MacGowan H, McGinlay M, Burgess R, Straw S, Simms A D, Gatenby V K, Sengupta A, Walker A M N, Saunderson C, Paton M F, Bridge K I, Gierula J, Witte K K, Cubbon R M, Kearney M T
Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
BMC Med. 2025 May 28;23(1):303. doi: 10.1186/s12916-025-04137-4.
Socioeconomic deprivation is associated with adverse clinical outcomes in patients with heart failure (HF). However, in the context of improved medical and device therapy for HF, it is unknown whether the influence of socioeconomic deprivation on HF outcomes is changing over time, especially in relation to evolving life expectancy patterns in the general population. Therefore, we aimed to describe temporal trends in the association of socioeconomic deprivation with loss of actuarially predicted life expectancy amongst ambulatory patients with HF.
Between 2006 and 2014, 1802 patients (73.2% male, mean age 69.6 years) with HF and left ventricular ejection fraction ≤ 45% were consecutively recruited across four hospitals in the United Kingdom (UK). Patients were stratified into socioeconomic deprivation tertiles defined by the UK Index of Multiple Deprivation (IMD) score with IMD tertile 1 denoting the least deprived and IMD tertile 3 the most deprived. The primary outcome was all-cause mortality, and relative survival predictions-in relation to age- and sex-matched background mortality rates-were calculated using UK National Life Tables. Relative survival was illustrated in terms of excess mortality risk and years of life expectancy lost. Recruitment period was split into 3-year intervals (2006-2008, 2009-2011 and 2012-2014).
During a median follow-up of 5.0 years, 1302 participants (72.3%) died. Unadjusted mortality rate was highest in tertile 2. However, adjusted to the age-sex matched UK population, a stepwise increase in excess mortality risk was observed across tertiles, with tertile 1 experiencing an excess mortality risk of 11.1% (95% CI: 6.1-16.1%) and tertile 3 24.2% (95% CI: 19.4-28.0%). This corresponded to a loss of life expectancy of 1.76 years (95% CI: 1.50-2.03) for tertile 1 and 2.30 years (95% CI: 2.03-2.57) for tertile 3 over a 10-year period. We observed disparity in actuarial survival between tertiles over time, with participants in tertile 1 losing less life expectancy at 10 years compared to those in tertiles 2 and 3. However this was only statistically significant for those recruited between 2012 and 2014 (p < 0.05).
The impact of socioeconomic deprivation on HF outcomes in an unselected diverse UK population appears to have worsened over time.
社会经济剥夺与心力衰竭（HF）患者的不良临床结局相关。然而，在HF的药物和器械治疗有所改善的背景下，社会经济剥夺对HF结局的影响是否随时间变化尚不清楚，尤其是与普通人群不断变化的预期寿命模式相关的情况。因此，我们旨在描述社会经济剥夺与门诊HF患者精算预测预期寿命损失之间关联的时间趋势。
2006年至2014年期间，在英国（UK）的四家医院连续招募了1802例HF患者（男性占73.2%，平均年龄69.6岁），其左心室射血分数≤45%。患者根据英国多重剥夺指数（IMD）评分分为社会经济剥夺三分位数，IMD三分位数1表示剥夺程度最低，IMD三分位数3表示剥夺程度最高。主要结局是全因死亡率，并使用英国国民生命表计算相对于年龄和性别匹配的背景死亡率的相对生存预测。相对生存情况用超额死亡风险和预期寿命损失年数来表示。招募期分为3年间隔（2006 - 2008年、2009 - 2011年和2012 - 2014年）。
在中位随访5.0年期间，1302名参与者（72.3%）死亡。未调整的死亡率在三分位数2中最高。然而，调整到年龄 - 性别匹配的英国人群后，三分位数之间的超额死亡风险呈逐步增加，三分位数1的超额死亡风险为11.1%（95%置信区间：6.1 - 16.1%），三分位数3为24.2%（95%置信区间：19.4 - 28.0%）。这相当于在10年期间，三分位数1的预期寿命损失为1.76年（95%置信区间：1.50 - 2.03），三分位数3为2.30年（95%置信区间：2.03 - 2.57）。我们观察到三分位数之间的精算生存随时间存在差异，与三分位数2和3的参与者相比，三分位数1的参与者在10年时预期寿命损失较少。然而，这仅在2012年至2014年招募的患者中具有统计学意义（p < 0.05）。
随着时间的推移，社会经济剥夺对未选择的英国多样化人群中HF结局的影响似乎有所恶化。
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