Widening gap in life expectancy between patients with heart failure living in most and least deprived areas: a longitudinal cohort study.

Abstract

Background: 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.

Methods: 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).

Results: 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).

Conclusions: The impact of socioeconomic deprivation on HF outcomes in an unselected diverse UK population appears to have worsened over time.