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Socioeconomic factors and mortality in patients with atrial fibrillation-a cohort study in Swedish primary care

Wändell, Per LU ; Carlsson, Axel C. ; Gasevic, Danijela ; Holzmann, Martin J. ; Ärnlöv, Johan ; Sundquist, Jan LU and Sundquist, Kristina LU (2018) In European Journal of Public Health 28(6). p.1103-1109
Abstract

Background: Preventing ischaemic stroke attracts significant focus in atrial fibrillation (AF) cases. Less is known on the association between socioeconomic factors and mortality and cardiovascular outcomes in patients with AF. Methods: Our study population included adults (n=12 283) ≥45 years diagnosed with AF at 75 primary care centres in Sweden 2001-07. Cox regression was used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs) for the association between the exposures educational level, marital status, neighbourhood socioeconomic status and the outcomes all-cause mortality, after adjustment for age, and comorbid cardiovascular conditions. Results: During a mean of 5.8 years (SD 2.4) of follow-up, 3954 (32.3%)... (More)

Background: Preventing ischaemic stroke attracts significant focus in atrial fibrillation (AF) cases. Less is known on the association between socioeconomic factors and mortality and cardiovascular outcomes in patients with AF. Methods: Our study population included adults (n=12 283) ≥45 years diagnosed with AF at 75 primary care centres in Sweden 2001-07. Cox regression was used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs) for the association between the exposures educational level, marital status, neighbourhood socioeconomic status and the outcomes all-cause mortality, after adjustment for age, and comorbid cardiovascular conditions. Results: During a mean of 5.8 years (SD 2.4) of follow-up, 3954 (32.3%) patients had died; 1971 were women (35.0%) and 1983 were men (29.8%). Higher educational level was associated with a reduced mortality in fully adjusted models: HR 0.85 (95% CI 0.77-0.96) for secondary school in men, HR 0.73 (95% CI 0.60-0.88) for college/university in women, and HR 0.82 (95% CI 0.71-0.94) for college/university in men, compared to primary school. Unmarried men and divorced men had an increased risk of death, compared with married men: HR 1.25 (95% CI 1.05-1.50), and HR 1.23 (95% CI 1.07-1.42), respectively. College/university education level was also associated with lower risk of myocardial infarction in men and women, and lower risk of congestive heart failure in women. Conclusion: More attention could be paid to individuals of lower levels of formal education, and unmarried men, in order to provide timely management for AF and prevent its debilitating complications.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
European Journal of Public Health
volume
28
issue
6
pages
7 pages
publisher
Oxford University Press
external identifiers
  • pmid:29746622
  • scopus:85056700296
ISSN
1101-1262
DOI
10.1093/eurpub/cky075
language
English
LU publication?
yes
id
f39752df-d856-4080-a530-4760dd2e5090
date added to LUP
2018-11-27 07:53:02
date last changed
2020-07-08 04:34:39
@article{f39752df-d856-4080-a530-4760dd2e5090,
  abstract     = {<p>Background: Preventing ischaemic stroke attracts significant focus in atrial fibrillation (AF) cases. Less is known on the association between socioeconomic factors and mortality and cardiovascular outcomes in patients with AF. Methods: Our study population included adults (n=12 283) ≥45 years diagnosed with AF at 75 primary care centres in Sweden 2001-07. Cox regression was used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs) for the association between the exposures educational level, marital status, neighbourhood socioeconomic status and the outcomes all-cause mortality, after adjustment for age, and comorbid cardiovascular conditions. Results: During a mean of 5.8 years (SD 2.4) of follow-up, 3954 (32.3%) patients had died; 1971 were women (35.0%) and 1983 were men (29.8%). Higher educational level was associated with a reduced mortality in fully adjusted models: HR 0.85 (95% CI 0.77-0.96) for secondary school in men, HR 0.73 (95% CI 0.60-0.88) for college/university in women, and HR 0.82 (95% CI 0.71-0.94) for college/university in men, compared to primary school. Unmarried men and divorced men had an increased risk of death, compared with married men: HR 1.25 (95% CI 1.05-1.50), and HR 1.23 (95% CI 1.07-1.42), respectively. College/university education level was also associated with lower risk of myocardial infarction in men and women, and lower risk of congestive heart failure in women. Conclusion: More attention could be paid to individuals of lower levels of formal education, and unmarried men, in order to provide timely management for AF and prevent its debilitating complications.</p>},
  author       = {Wändell, Per and Carlsson, Axel C. and Gasevic, Danijela and Holzmann, Martin J. and Ärnlöv, Johan and Sundquist, Jan and Sundquist, Kristina},
  issn         = {1101-1262},
  language     = {eng},
  number       = {6},
  pages        = {1103--1109},
  publisher    = {Oxford University Press},
  series       = {European Journal of Public Health},
  title        = {Socioeconomic factors and mortality in patients with atrial fibrillation-a cohort study in Swedish primary care},
  url          = {http://dx.doi.org/10.1093/eurpub/cky075},
  doi          = {10.1093/eurpub/cky075},
  volume       = {28},
  year         = {2018},
}