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Socioeconomic deprivation and survival after heart transplantation in England
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Evans, Jonathan D. W., Kaptoge, Stephen, Caleyachetty, Rishi, Di Angelantonio, Emanuele, Lewis, Clive, Parameshwar, K. Jayan and Pettit, Stephen J. (2016) Socioeconomic deprivation and survival after heart transplantation in England. Circulation: Cardiovascular Quality and Outcomes, 9 (6). pp. 695-703. doi:10.1161/CIRCOUTCOMES.116.002652 ISSN 1941-7713.
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Official URL: http://dx.doi.org/10.1161/CIRCOUTCOMES.116.002652
Abstract
Background—Socioeconomic deprivation (SED) is associated with shorter survival across a range of cardiovascular and noncardiovascular diseases. The association of SED with survival after heart transplantation in England, where there is universal healthcare provision, is unknown.
Methods and Results—Long-term follow-up data were obtained for all patients in England who underwent heart transplantation between 1995 and 2014. We used the United Kingdom Index of Multiple Deprivation (UK IMD), a neighborhood level measure of SED, to estimate the relative degree of deprivation for each recipient. Cox proportional hazard models were used to examine the association between SED and overall survival and conditional survival (dependant on survival at 1 year after transplantation) during follow-up. Models were stratified by transplant center and adjusted for donor and recipient age and sex, ethnicity, serum creatinine, diabetes mellitus, and heart failure cause. A total of 2384 patients underwent heart transplantation. There were 1101 deaths during 17 040 patient-year follow-up. Median overall survival was 12.6 years, and conditional survival was 15.6 years. Comparing the most deprived with the least deprived quintile, adjusted hazard ratios for all-cause mortality were 1.27 (1.04–1.55; P=0.021) and 1.59 (1.22–2.09; P=0.001) in the overall and conditional models, respectively. Median overall survival and conditional survival were 3.4 years shorter in the most deprived quintile than in the least deprived.
Conclusions—Higher SED is associated with shorter survival in heart transplant recipients in England and should be considered when comparing outcomes between centers. Future research should seek to identify modifiable mediators of this association.
Item Type: | Journal Article | ||||||
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Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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Journal or Publication Title: | Circulation: Cardiovascular Quality and Outcomes | ||||||
Publisher: | Lippincott Williams & Wilkins | ||||||
ISSN: | 1941-7713 | ||||||
Official Date: | 1 November 2016 | ||||||
Dates: |
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Volume: | 9 | ||||||
Number: | 6 | ||||||
Page Range: | pp. 695-703 | ||||||
DOI: | 10.1161/CIRCOUTCOMES.116.002652 | ||||||
Status: | Peer Reviewed | ||||||
Publication Status: | Published | ||||||
Access rights to Published version: | Open Access (Creative Commons) |
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