Socioeconomic deprivation and post-discharge mortality in heart failure: evidence from a nationwide universal health coverage system

Hugo Guillermou, Vera Georgescu, Nicolas Girerd (), Hariette van Spall, Guillaume Baudry (), Grégoire Mercier () and François Roubille ()
Additional contact information
Hugo Guillermou: CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
Vera Georgescu: CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
Nicolas Girerd: DCAC - Défaillance Cardiovasculaire Aiguë et Chronique - CHRU Nancy - Centre Hospitalier Régional Universitaire de Nancy - INSERM - Institut National de la Santé et de la Recherche Médicale - UL - Université de Lorraine, CIC-P - Centre d'investigation clinique plurithématique Pierre Drouin [Nancy] - CIC 1433 - Centre d'investigation clinique de Nancy - CHRU Nancy - Centre Hospitalier Régional Universitaire de Nancy - INSERM - Institut National de la Santé et de la Recherche Médicale - UL - Université de Lorraine, INI-CRCT - Cardiovascular and Renal Clinical Trialists [Vandoeuvre-les-Nancy] - Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu [Nancy], Cardiovascular & Renal Clinical Trialists - CRCT - French-Clinical Research Infrastructure Network - F-CRIN [Paris]
Hariette van Spall: McMaster University [Hamilton, Ontario]
Guillaume Baudry: DCAC - Défaillance Cardiovasculaire Aiguë et Chronique - CHRU Nancy - Centre Hospitalier Régional Universitaire de Nancy - INSERM - Institut National de la Santé et de la Recherche Médicale - UL - Université de Lorraine, CIC-P - Centre d'investigation clinique plurithématique Pierre Drouin [Nancy] - CIC 1433 - Centre d'investigation clinique de Nancy - CHRU Nancy - Centre Hospitalier Régional Universitaire de Nancy - INSERM - Institut National de la Santé et de la Recherche Médicale - UL - Université de Lorraine, INI-CRCT - Cardiovascular and Renal Clinical Trialists [Vandoeuvre-les-Nancy] - Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu [Nancy], Cardiovascular & Renal Clinical Trialists - CRCT - French-Clinical Research Infrastructure Network - F-CRIN [Paris], REICATRA, Recherche et Enseignement en IC Avancée, Transplantation, Assistance
Grégoire Mercier: IDESP - Institut Desbrest d'Epidémiologie et de Santé Publique - INSERM - Institut National de la Santé et de la Recherche Médicale - UM - Université de Montpellier, CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
François Roubille: PhyMedExp - Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] - INSERM - Institut National de la Santé et de la Recherche Médicale - CNRS - Centre National de la Recherche Scientifique - UM - Université de Montpellier, CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]

Post-Print from HAL

Abstract: Aims: Heart failure (HF) is characterized by high mortality rates during hospitalization and after discharge. Socioeconomic deprivation and inequalities are often barriers to effective treatment, substantially impacting mortality in chronic illnesses. We investigated the association between socioeconomic deprivation, all-cause mortality, and HF readmission among patients hospitalized for HF in France. Methods and results: We conducted a retrospective cohort study including all adults hospitalized for worsening HF in France in 2018, using data from the national health insurance database. We estimated the association between area-level socioeconomic disadvantage quintiles and income inequality quantified by the Gini index and the outcomes of all-cause mortality and HF readmission using adjusted survival models. Among 92 111 patients (median age 82 years; 50.5% female), 29.7% were readmitted and 25.9% died within 1 year. Higher levels of deprivation were associated with increased one-year mortality, with HR ranging from 1.03 to 1.06, but not consistently across all quintiles. This association persisted in adjusted analysis at 1 (HR 1.11, 1.07–1.16, P < 0.001, for the most vs. least deprived) and 2 years (HR 1.11, 1.07–1.15, P < 0.001). In contrast, socioeconomic deprivation was not significantly associated with readmission risk, and the Gini index showed no association with either mortality or readmission. Conclusion: In a country with universal healthcare, area-level socioeconomic deprivation was modestly associated with higher mortality after HF hospitalization, but not with readmission risk. Society-level income inequality showed no relationship with either outcome.

Date: 2026
New Economics Papers: this item is included in nep-inv
Note: View the original document on HAL open archive server: https://hal.science/hal-05562498v1
References: Add references at CitEc
Citations:

Published in European Heart Journal. Quality of Care and Clinical Outcomes, 2026, 12 (5), pp.664-675. ⟨10.1093/ehjqcco/qcag008⟩

Downloads: (external link)
https://hal.science/hal-05562498v1/document (application/pdf)

Related works:
This item may be available elsewhere in EconPapers: Search for items with the same title.

Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text

Persistent link: https://EconPapers.repec.org/RePEc:hal:journl:hal-05562498

DOI: 10.1093/ehjqcco/qcag008

Access Statistics for this paper

More papers in Post-Print from HAL
Bibliographic data for series maintained by CCSD ().