Rurality, Death, and Healthcare Utilization in Heart Failure in the Community
Background Prior reports indicate that living in a rural area may be associated with worse health outcomes. However, data on rurality and heart failure (HF) outcomes are scarce. Methods and Results Residents from 6 southeastern Minnesota counties with a first‐ever code for HF (International Classifi...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2021-02-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.120.018026 |
| _version_ | 1811334127805267968 |
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| author | Sheila M. Manemann Jennifer St. Sauver Carrie Henning‐Smith Lila J. Finney Rutten Alanna M. Chamberlain Matteo Fabbri Susan A. Weston Ruoxiang Jiang Véronique L. Roger |
| author_facet | Sheila M. Manemann Jennifer St. Sauver Carrie Henning‐Smith Lila J. Finney Rutten Alanna M. Chamberlain Matteo Fabbri Susan A. Weston Ruoxiang Jiang Véronique L. Roger |
| author_sort | Sheila M. Manemann |
| collection | DOAJ |
| description | Background Prior reports indicate that living in a rural area may be associated with worse health outcomes. However, data on rurality and heart failure (HF) outcomes are scarce. Methods and Results Residents from 6 southeastern Minnesota counties with a first‐ever code for HF (International Classification of Diseases, Ninth Revision [ICD‐9], code 428, and International Classification of Diseases, Tenth Revision [ICD‐10] code I50) between January 1, 2013 and December 31, 2016, were identified. Resident address was classified according to the rural‐urban commuting area codes. Rurality was defined as living in a nonmetropolitan area. Cox regression was used to analyze the association between living in a rural versus urban area and death; Andersen‐Gill models were used for hospitalization and emergency department visits. Among 6003 patients with HF (mean age 74 years, 48% women), 43% lived in a rural area. Rural patients were older and had a lower educational attainment and less comorbidity compared with patients living in urban areas (P<0.001). After a mean (SD) follow‐up of 2.8 (1.7) years, 2440 deaths, 20 506 emergency department visits, and 11 311 hospitalizations occurred. After adjustment, rurality was independently associated with an increased risk of death (hazard ratio [HR], 1.18; 95% CI, 1.09–1.29) and a reduced risk of emergency department visits (HR, 0.89; 95% CI, 0.82–0.97) and hospitalizations (HR, 0.78; 95% CI, 0.73–0.84). Conclusions Among patients with HF, living in a rural area is associated with an increased risk of death and fewer emergency department visits and hospitalizations. Further study to identify and address the mechanisms through which rural residence influences mortality and healthcare utilization in HF is needed in order to reduce disparities in rural health. |
| first_indexed | 2024-04-13T17:03:12Z |
| format | Article |
| id | doaj.art-571213f7ccf14a539208f2df07099f58 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-13T17:03:12Z |
| publishDate | 2021-02-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-571213f7ccf14a539208f2df07099f582022-12-22T02:38:35ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802021-02-0110410.1161/JAHA.120.018026Rurality, Death, and Healthcare Utilization in Heart Failure in the CommunitySheila M. Manemann0Jennifer St. Sauver1Carrie Henning‐Smith2Lila J. Finney Rutten3Alanna M. Chamberlain4Matteo Fabbri5Susan A. Weston6Ruoxiang Jiang7Véronique L. Roger8Department of Health Sciences Research Mayo Clinic Rochester MNDepartment of Health Sciences Research Mayo Clinic Rochester MNDivision of Health Policy and Management University of Minnesota School of Public Health Minneapolis MNDepartment of Health Sciences Research Mayo Clinic Rochester MNDepartment of Health Sciences Research Mayo Clinic Rochester MNDepartment of Health Sciences Research Mayo Clinic Rochester MNDepartment of Health Sciences Research Mayo Clinic Rochester MNDepartment of Health Sciences Research Mayo Clinic Rochester MNDepartment of Health Sciences Research Mayo Clinic Rochester MNBackground Prior reports indicate that living in a rural area may be associated with worse health outcomes. However, data on rurality and heart failure (HF) outcomes are scarce. Methods and Results Residents from 6 southeastern Minnesota counties with a first‐ever code for HF (International Classification of Diseases, Ninth Revision [ICD‐9], code 428, and International Classification of Diseases, Tenth Revision [ICD‐10] code I50) between January 1, 2013 and December 31, 2016, were identified. Resident address was classified according to the rural‐urban commuting area codes. Rurality was defined as living in a nonmetropolitan area. Cox regression was used to analyze the association between living in a rural versus urban area and death; Andersen‐Gill models were used for hospitalization and emergency department visits. Among 6003 patients with HF (mean age 74 years, 48% women), 43% lived in a rural area. Rural patients were older and had a lower educational attainment and less comorbidity compared with patients living in urban areas (P<0.001). After a mean (SD) follow‐up of 2.8 (1.7) years, 2440 deaths, 20 506 emergency department visits, and 11 311 hospitalizations occurred. After adjustment, rurality was independently associated with an increased risk of death (hazard ratio [HR], 1.18; 95% CI, 1.09–1.29) and a reduced risk of emergency department visits (HR, 0.89; 95% CI, 0.82–0.97) and hospitalizations (HR, 0.78; 95% CI, 0.73–0.84). Conclusions Among patients with HF, living in a rural area is associated with an increased risk of death and fewer emergency department visits and hospitalizations. Further study to identify and address the mechanisms through which rural residence influences mortality and healthcare utilization in HF is needed in order to reduce disparities in rural health.https://www.ahajournals.org/doi/10.1161/JAHA.120.018026heart failureoutcomesruralrural‐urban commuting area |
| spellingShingle | Sheila M. Manemann Jennifer St. Sauver Carrie Henning‐Smith Lila J. Finney Rutten Alanna M. Chamberlain Matteo Fabbri Susan A. Weston Ruoxiang Jiang Véronique L. Roger Rurality, Death, and Healthcare Utilization in Heart Failure in the Community Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease heart failure outcomes rural rural‐urban commuting area |
| title | Rurality, Death, and Healthcare Utilization in Heart Failure in the Community |
| title_full | Rurality, Death, and Healthcare Utilization in Heart Failure in the Community |
| title_fullStr | Rurality, Death, and Healthcare Utilization in Heart Failure in the Community |
| title_full_unstemmed | Rurality, Death, and Healthcare Utilization in Heart Failure in the Community |
| title_short | Rurality, Death, and Healthcare Utilization in Heart Failure in the Community |
| title_sort | rurality death and healthcare utilization in heart failure in the community |
| topic | heart failure outcomes rural rural‐urban commuting area |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.120.018026 |
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