Social determinants of health and clinical outcomes among patients with atrial fibrillation. Evidence from a global federated health research network.

Simoni, Amalie H, Bucci, Tommaso ORCID: 0000-0003-2895-6234, Romiti, Giulio Francesco, Frydenlund, Juliane, Johnsen, Søren Paaske, Abdul-Rahim, Azmil H ORCID: 0000-0002-1318-4027 and Lip, Gregory YH (2023) Social determinants of health and clinical outcomes among patients with atrial fibrillation. Evidence from a global federated health research network. QJM : monthly journal of the Association of Physicians. hcad275-.

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Official URL: http://dx.doi.org/10.1093/qjmed/hcad275

Abstract

<h4>Background</h4>Few studies have investigated the role of SDoH in patients with atrial fibrillation (AF).<h4>Aim</h4>To investigate the relationship between SDoH and adverse events in a large multinational AF cohort.<h4>Design</h4>Retrospective study utilizing a global federated health research network (TriNetX).<h4>Methods</h4>Patients with AF were categorized as socially deprived defined according to ICD codes based on three SDoHs: i) extreme poverty; ii) unemployment; iii) and/or problems related with living alone. The outcomes were the five-year risk of a composite outcomes of all-cause death, hospitalization, ischemic heart disease, stroke, heart failure, or severe ventricular arrhythmias. Cox-regression was used to compute hazard rate ratios (HRs) and 95% confidence intervals (CI) following 1:1 propensity score matching (PSM).<h4>Results</h4>The study included 24,631 socially deprived (68.8 ± 16.0 years; females 51.8%) and 2,462,092 non-deprived AF patients (75.5 ± 13.1 years; females 43.8%). Before PSM, socially deprived patients had a higher risk of the composite outcome (HR 1.9, 95%CI 1.87-1.93), all-cause death (HR 1.34, 95%CI 1.28-1.39), hospitalization (HR 2.01, 95%CI 1.98-2.04), ischemic heart disease (HR 1.67, 95%CI 1.64-1.70), stroke (HR 2.60, 95%CI 2.51-2.64), heart failure (HR 1.91, 95%CI 1.86-1.96) and severe ventricular arrhythmias (HR 1.83, 95%CI 1.76-1.90) compared to non-deprived AF patients. The PSM based hazard ratios for the primary composite outcome were 1.54 (95%CI 1.49-1.60) for the unemployed AF patients; 1.39 (95%CI 1.31-1.47) for patients with extreme poverty or with low income; and 1.42 (95%CI 1.37-1.47) for those with problems related with living alone.<h4>Conclusions</h4>In patients with AF, social deprivation is associated with an increased risk of death and adverse cardiac events. The presence of possible unmeasured bias associated with the retrospective design requires confirmation in future prospective studies.

Item Type:	Article
Uncontrolled Keywords:	Atrial fibrillation, Cardiovascular events, Public health
Divisions:	Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Life Courses and Medical Sciences
Depositing User:	Symplectic Admin
Date Deposited:	29 Feb 2024 11:50
Last Modified:	29 Feb 2024 11:50
DOI:	10.1093/qjmed/hcad275
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3179009