Socioeconomic deprivation and post-discharge mortality in heart failure: evidence from a nationwide universal health coverage system
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.
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BibTeX
@article{guillermou2026socioeconomic,
title = {{Socioeconomic deprivation and post-discharge mortality in heart failure: evidence from a nationwide universal health coverage system}},
author = {Hugo Guillermou and Vera Georgescu and Nicolas Girerd and Hariette van Spall and Guillaume Baudry and Grégoire Mercier and François Roubille},
journal = {European Heart Journal. Quality of Care and Clinical Outcomes},
year = {2026},
month = oct,
doi = {10.1093/ehjqcco/qcag008},
url = {https://hal.science/hal-05562498v1},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Socioeconomic deprivation and post-discharge mortality in heart failure: evidence from a nationwide universal health coverage system
AU - Hugo Guillermou
AU - Vera Georgescu
AU - Nicolas Girerd
AU - Hariette van Spall
AU - Guillaume Baudry
AU - Grégoire Mercier
AU - François Roubille
PY - 2026
DA - 2026/10/28
JO - European Heart Journal. Quality of Care and Clinical Outcomes
DO - 10.1093/ehjqcco/qcag008
UR - https://hal.science/hal-05562498v1
AB - 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.
SN - 2058-5225
SN - 2058-1742
ER -