Gendered social determinants of health and risk of major adverse outcomes in atrial fibrillation.

IF 5.9 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Jonathan Houle, Marco Proietti, Valeria Raparelli, Clare L Atzema, Colleen M Norris, Michal Abrahamowicz, Gregory Yh Lip, Giuseppe Boriani, Louise Pilote
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引用次数: 0

Abstract

Introduction: Atrial fibrillation (AF) is associated with an increased risk of adverse outcomes. Clinical risk factors have been identified as predictors of such outcomes, but social determinants of health (SDOH) may also play a role. We evaluated the associations between gendered SDOH (unevenly distributed between sexes) and adverse outcomes in AF.

Methods: This is a retrospective cohort study using data from a European registry of AF patients from 250 centers and twenty-seven countries. Gendered SDOH included education, living status, subscales of the EQ-5D-5L questionnaire, behavioral factors, and country-level gender inequality index (GII). The primary outcome was a composite of major adverse cardiovascular events and all-cause mortality. We used multivariate logistic regression models to identify associations between SDOH and the primary outcome.

Results: The study population comprised of 11,096 patients (mean age 69.2 years; 40.7 % females), with 75.6 % of patients having a high-risk CHA2DS2-VASc score. Most participants had secondary education, were physically inactive, lived in countries with gender equity and reported at least moderately elevated quality of life measures; they were less likely to live alone, smoke or drink alcohol. After adjustment for clinical factors, not having any post-secondary education (OR:1.17 95 %CI:1.05-1.28), reporting poorer health status (OR:1.08 95 %CI:1.05-1.11), living in a country with a higher GII (higher gender inequity) (OR:1.12 95 %CI:1.03-1.22 each 0.100), reporting reduced mobility (OR:1.18 95 %CI:1.02-1.38) and reduced self-care (OR:1.35;95 %CI:1.14-1.61) were independently associated with worse outcomes.

Conclusions: Gendered SDOH are independently associated with adverse events in patients with AF. These factors should be considered for assessment of risk and as potential targets for interventions to improve outcomes.

Condensed abstract: Atrial fibrillation (AF) is associated with adverse outcomes and social determinants of health (SDOH), which are gendered, may predict adverse outcomes in AF. We used a registry of AF patients from 27 European countries. Multivariate logistic regressions were used to investigate the associations between gendered SDOH and the primary outcome, a composite of major adverse cardiovascular events and all-cause mortality. Several SDOH were independent predictors: no higher education (OR:1.17;95 %CI:1.05-1.28), lower health (OR:1.08;95 %CI:1.05-1.11), higher GII (OR:1.12;95 %CI:1.03-1.22 each 0.100), reduced mobility (OR:1.18;95 %CI:1.02-1.38) and reduced self-care (OR:1.35;95 %CI:1.14-1.61). Gendered SDOH are independently associated with adverse events in AF.

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来源期刊
European Journal of Internal Medicine
European Journal of Internal Medicine 医学-医学:内科
CiteScore
9.60
自引率
6.20%
发文量
364
审稿时长
20 days
期刊介绍: The European Journal of Internal Medicine serves as the official journal of the European Federation of Internal Medicine and is the primary scientific reference for European academic and non-academic internists. It is dedicated to advancing science and practice in internal medicine across Europe. The journal publishes original articles, editorials, reviews, internal medicine flashcards, and other relevant information in the field. Both translational medicine and clinical studies are emphasized. EJIM aspires to be a leading platform for excellent clinical studies, with a focus on enhancing the quality of healthcare in European hospitals.
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