Rural-urban differentials in 30-day and 1-year mortality following first-ever heart failure hospitalisation in Western Australia: a population-based study using data linkage

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Abstract

Objectives: We examined differentials in short-term (30-day mortality) and 1-year mortality (in 30-day survivors) following index (first-ever) hospitalisation for heart failure (HF), between rural and metropolitan patients resident in Western Australia. Design: A population-based cohort study. Setting: Hospitalised patients in Western Australia, Australia. Participants: Index patients aged 20-84 years with a first-ever hospitalisation for HF between 2000 and 2009 (with no prior admissions for HF in previous 10 years), identified using the Western Australia linked health data. Main outcome measures: 30-day and 1-year allcause mortality (in 30-day survivors) following index admission for HF. Results: Of 17 379 index patients with HF identified, 25.9% (4499) were from rural areas. Rural patients were significantly younger at first HF hospitalisation than metropolitan patients. Aboriginal patients comprised 1.9% of metropolitan and 17.2% of rural patients. Despite some statistical differences, the prevalence of antecedents including ischaemic heart disease, hypertension, diabetes and chronic kidney disease was high (>20%) in both subpopulations. After adjusting for age only, patients from rural areas had a higher risk of 30-day death (OR 1.16 (95% CI 1.01 to 1.33)) and 1-year death in 30-day survivors (HR 1.11 (95% CI 1.01 to 1.23)). These relative risk estimates increased and remained significant after further progressive adjustments for Aboriginality, socioeconomic status, insurance status, emergency presentation, individual comorbidities and revascularisation with OR 1.25 (1.06 to 1.48) for 30-day mortality and HR 1.13 (1.02 to 1.27) for 1-year mortality. The addition of the weighted Charlson index to the 30-day model improved the 'c' statistic (under the receiver operating characteristic curve) from 0.656 (using a variation of administrative claims model) to 0.714.
Original languageEnglish
Pages (from-to)e004724
JournalBMJ Open
Volume4
Issue number5
DOIs
Publication statusPublished - 2 May 2014

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Western Australia
Information Storage and Retrieval
Hospitalization
Heart Failure
Mortality
Population
Survivors
Insurance Coverage
Chronic Renal Insufficiency
Social Class
ROC Curve
Myocardial Ischemia
Comorbidity
Emergencies
Cohort Studies
Outcome Assessment (Health Care)
Hypertension

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@article{899f365f53434de49ff55c1738b7bcf5,
title = "Rural-urban differentials in 30-day and 1-year mortality following first-ever heart failure hospitalisation in Western Australia: a population-based study using data linkage",
abstract = "Objectives: We examined differentials in short-term (30-day mortality) and 1-year mortality (in 30-day survivors) following index (first-ever) hospitalisation for heart failure (HF), between rural and metropolitan patients resident in Western Australia. Design: A population-based cohort study. Setting: Hospitalised patients in Western Australia, Australia. Participants: Index patients aged 20-84 years with a first-ever hospitalisation for HF between 2000 and 2009 (with no prior admissions for HF in previous 10 years), identified using the Western Australia linked health data. Main outcome measures: 30-day and 1-year allcause mortality (in 30-day survivors) following index admission for HF. Results: Of 17 379 index patients with HF identified, 25.9{\%} (4499) were from rural areas. Rural patients were significantly younger at first HF hospitalisation than metropolitan patients. Aboriginal patients comprised 1.9{\%} of metropolitan and 17.2{\%} of rural patients. Despite some statistical differences, the prevalence of antecedents including ischaemic heart disease, hypertension, diabetes and chronic kidney disease was high (>20{\%}) in both subpopulations. After adjusting for age only, patients from rural areas had a higher risk of 30-day death (OR 1.16 (95{\%} CI 1.01 to 1.33)) and 1-year death in 30-day survivors (HR 1.11 (95{\%} CI 1.01 to 1.23)). These relative risk estimates increased and remained significant after further progressive adjustments for Aboriginality, socioeconomic status, insurance status, emergency presentation, individual comorbidities and revascularisation with OR 1.25 (1.06 to 1.48) for 30-day mortality and HR 1.13 (1.02 to 1.27) for 1-year mortality. The addition of the weighted Charlson index to the 30-day model improved the 'c' statistic (under the receiver operating characteristic curve) from 0.656 (using a variation of administrative claims model) to 0.714.",
author = "Katherine Teng and Judith Katzenellenbogen and Joe Hung and Matthew Knuiman and Frank Sanfilippo and Elizabeth Geelhoed and Michael Hobbs and Sandra Thompson",
year = "2014",
month = "5",
day = "2",
doi = "10.1136/bmjopen-2013-004724",
language = "English",
volume = "4",
pages = "e004724",
journal = "BMJ (Open)",
issn = "2044-6055",
publisher = "John Wiley & Sons",
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TY - JOUR

T1 - Rural-urban differentials in 30-day and 1-year mortality following first-ever heart failure hospitalisation in Western Australia: a population-based study using data linkage

AU - Teng, Katherine

AU - Katzenellenbogen, Judith

AU - Hung, Joe

AU - Knuiman, Matthew

AU - Sanfilippo, Frank

AU - Geelhoed, Elizabeth

AU - Hobbs, Michael

AU - Thompson, Sandra

PY - 2014/5/2

Y1 - 2014/5/2

N2 - Objectives: We examined differentials in short-term (30-day mortality) and 1-year mortality (in 30-day survivors) following index (first-ever) hospitalisation for heart failure (HF), between rural and metropolitan patients resident in Western Australia. Design: A population-based cohort study. Setting: Hospitalised patients in Western Australia, Australia. Participants: Index patients aged 20-84 years with a first-ever hospitalisation for HF between 2000 and 2009 (with no prior admissions for HF in previous 10 years), identified using the Western Australia linked health data. Main outcome measures: 30-day and 1-year allcause mortality (in 30-day survivors) following index admission for HF. Results: Of 17 379 index patients with HF identified, 25.9% (4499) were from rural areas. Rural patients were significantly younger at first HF hospitalisation than metropolitan patients. Aboriginal patients comprised 1.9% of metropolitan and 17.2% of rural patients. Despite some statistical differences, the prevalence of antecedents including ischaemic heart disease, hypertension, diabetes and chronic kidney disease was high (>20%) in both subpopulations. After adjusting for age only, patients from rural areas had a higher risk of 30-day death (OR 1.16 (95% CI 1.01 to 1.33)) and 1-year death in 30-day survivors (HR 1.11 (95% CI 1.01 to 1.23)). These relative risk estimates increased and remained significant after further progressive adjustments for Aboriginality, socioeconomic status, insurance status, emergency presentation, individual comorbidities and revascularisation with OR 1.25 (1.06 to 1.48) for 30-day mortality and HR 1.13 (1.02 to 1.27) for 1-year mortality. The addition of the weighted Charlson index to the 30-day model improved the 'c' statistic (under the receiver operating characteristic curve) from 0.656 (using a variation of administrative claims model) to 0.714.

AB - Objectives: We examined differentials in short-term (30-day mortality) and 1-year mortality (in 30-day survivors) following index (first-ever) hospitalisation for heart failure (HF), between rural and metropolitan patients resident in Western Australia. Design: A population-based cohort study. Setting: Hospitalised patients in Western Australia, Australia. Participants: Index patients aged 20-84 years with a first-ever hospitalisation for HF between 2000 and 2009 (with no prior admissions for HF in previous 10 years), identified using the Western Australia linked health data. Main outcome measures: 30-day and 1-year allcause mortality (in 30-day survivors) following index admission for HF. Results: Of 17 379 index patients with HF identified, 25.9% (4499) were from rural areas. Rural patients were significantly younger at first HF hospitalisation than metropolitan patients. Aboriginal patients comprised 1.9% of metropolitan and 17.2% of rural patients. Despite some statistical differences, the prevalence of antecedents including ischaemic heart disease, hypertension, diabetes and chronic kidney disease was high (>20%) in both subpopulations. After adjusting for age only, patients from rural areas had a higher risk of 30-day death (OR 1.16 (95% CI 1.01 to 1.33)) and 1-year death in 30-day survivors (HR 1.11 (95% CI 1.01 to 1.23)). These relative risk estimates increased and remained significant after further progressive adjustments for Aboriginality, socioeconomic status, insurance status, emergency presentation, individual comorbidities and revascularisation with OR 1.25 (1.06 to 1.48) for 30-day mortality and HR 1.13 (1.02 to 1.27) for 1-year mortality. The addition of the weighted Charlson index to the 30-day model improved the 'c' statistic (under the receiver operating characteristic curve) from 0.656 (using a variation of administrative claims model) to 0.714.

U2 - 10.1136/bmjopen-2013-004724

DO - 10.1136/bmjopen-2013-004724

M3 - Article

VL - 4

SP - e004724

JO - BMJ (Open)

JF - BMJ (Open)

SN - 2044-6055

IS - 5

ER -