Association of household income and adverse outcomes in patients with atrial fibrillation

• Authors: Anna Rose LaRosa, University of Pittsburgh; J'Neka Claxton, Emory University; Wesley T. O'Neal, Emory University; Pamela L. Lutsey, University of Minnesota; Lin Y. Chen, University of Minnesota; Lindsay Bengtson, Optum; Alanna M. Chamberlain, Mayo Clinic; Alvaro Alonso, Emory University; Jared W. Magnani, University of Pittsburgh
• Journal Title: HEART
• Volume: Volume 106, Number 21
• Publisher: BMJ PUBLISHING GROUP | 2020-11-01, Pages 1679-1685
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1136/heartjnl-2019-316065
• Subjects: Health Sciences, Medicine and Surgery; Sociology, Public and Social Welfare
• Keywords: Science & Technology; Life Sciences & Biomedicine; Cardiac & Cardiovascular Systems; Cardiovascular System & Cardiology; atrial fibrillation; quality and outcomes of care; ACUTE MYOCARDIAL-INFARCTION; CARDIOVASCULAR-DISEASE; ATHEROSCLEROSIS RISK; SOCIOECONOMIC-STATUS; HEART-DISEASE; MORTALITY; CARE; EDUCATION

Abstract

Background Social determinants of health are relevant to cardiovascular outcomes but have had limited examination in atrial fibrillation (AF). Objectives The purpose of this study was to examine the association of annual household income and cardiovascular outcomes in individuals with AF. Methods 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). Results 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. Conclusions 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.