Impact of population density on mortality in patients hospitalized for heart failure – JROAD-DPC Registry Analysis –

Masaaki Konishi, Yasushi Matsuzawa, Toshiaki Ebina, Masami Kosuge, Masaomi Gohbara, Kunihiro Nishimura, Michikazu Nakai, Yoshihiro Miyamoto, Yoshihiko Saito, Hiroyuki Tsutsui, Issei Komuro, Hisao Ogawa, Kouichi Tamura, Kazuo Kimura

Research output: Contribution to journalArticle

Abstract

Background: There is little evidence regarding social and geographic factors in patients with heart failure (HF). We sought to investigate the association between in-hospital mortality of patients with HF and population density of the patients’ area of residence in Japan. Methods: The present study is a retrospective cohort analysis of the nationwide claim-based database, the Japanese Registry Of All cardiac and vascular Diseases-Diagnostic Procedure Combination (JROAD-DPC). We selected data of 196,286 hospitalized patients with HF (median age of 81 years and 51.8% males). Results: In-hospital mortality was 14.2%, 11.8%, and 9.5% in the lower, middle, and upper tertiles of population density, respectively. Age sub-analysis showed the largest absolute rural-urban disparity in mortality was 4.6% in the oldest subgroup (≥80 years). Multivariate analysis using mixed logistic regression model revealed that higher population density was associated with lower in-hospital mortality: multivariable-adjusted odds ratio (OR): 0.785, 95% confidence interval (CI): (0.713–0.864), p < 0.001 and 0.687, 95% CI: (0.623–0.757), p < 0.001 in the middle and upper tertiles, in comparison with the lower tertile as a reference, after adjustment for age, sex, the New York Heart Association class, comorbidities, and hospital volume. The same tendency was observed in propensity score analysis using 62,291 (in the lower vs. middle tertile) and 57,228 (in the lower vs. upper tertile) matched pairs (OR: 0.797, 95% CI: 0.725-0.877, p < 0.001 and OR: 0.695, 95% CI: 0.634–0.762, p < 0.001 in the middle and upper tertile, respectively). Conclusions: Higher population density was associated with lower in-hospital mortality in HF. More research is needed to gain insight into causality.

Original languageEnglish
JournalJournal of Cardiology
DOIs
Publication statusAccepted/In press - Jan 1 2019

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Population Density
Hospital Mortality
Vascular Diseases
Registries
Heart Diseases
Heart Failure
Confidence Intervals
Mortality
Odds Ratio
Logistic Models
Propensity Score
Geography
Causality
Comorbidity
Japan
Cohort Studies
Multivariate Analysis
Databases
Research

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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Impact of population density on mortality in patients hospitalized for heart failure – JROAD-DPC Registry Analysis –. / Konishi, Masaaki; Matsuzawa, Yasushi; Ebina, Toshiaki; Kosuge, Masami; Gohbara, Masaomi; Nishimura, Kunihiro; Nakai, Michikazu; Miyamoto, Yoshihiro; Saito, Yoshihiko; Tsutsui, Hiroyuki; Komuro, Issei; Ogawa, Hisao; Tamura, Kouichi; Kimura, Kazuo.

In: Journal of Cardiology, 01.01.2019.

Research output: Contribution to journalArticle

Konishi, M, Matsuzawa, Y, Ebina, T, Kosuge, M, Gohbara, M, Nishimura, K, Nakai, M, Miyamoto, Y, Saito, Y, Tsutsui, H, Komuro, I, Ogawa, H, Tamura, K & Kimura, K 2019, 'Impact of population density on mortality in patients hospitalized for heart failure – JROAD-DPC Registry Analysis –', Journal of Cardiology. https://doi.org/10.1016/j.jjcc.2019.09.008
Konishi, Masaaki ; Matsuzawa, Yasushi ; Ebina, Toshiaki ; Kosuge, Masami ; Gohbara, Masaomi ; Nishimura, Kunihiro ; Nakai, Michikazu ; Miyamoto, Yoshihiro ; Saito, Yoshihiko ; Tsutsui, Hiroyuki ; Komuro, Issei ; Ogawa, Hisao ; Tamura, Kouichi ; Kimura, Kazuo. / Impact of population density on mortality in patients hospitalized for heart failure – JROAD-DPC Registry Analysis –. In: Journal of Cardiology. 2019.
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abstract = "Background: There is little evidence regarding social and geographic factors in patients with heart failure (HF). We sought to investigate the association between in-hospital mortality of patients with HF and population density of the patients’ area of residence in Japan. Methods: The present study is a retrospective cohort analysis of the nationwide claim-based database, the Japanese Registry Of All cardiac and vascular Diseases-Diagnostic Procedure Combination (JROAD-DPC). We selected data of 196,286 hospitalized patients with HF (median age of 81 years and 51.8{\%} males). Results: In-hospital mortality was 14.2{\%}, 11.8{\%}, and 9.5{\%} in the lower, middle, and upper tertiles of population density, respectively. Age sub-analysis showed the largest absolute rural-urban disparity in mortality was 4.6{\%} in the oldest subgroup (≥80 years). Multivariate analysis using mixed logistic regression model revealed that higher population density was associated with lower in-hospital mortality: multivariable-adjusted odds ratio (OR): 0.785, 95{\%} confidence interval (CI): (0.713–0.864), p < 0.001 and 0.687, 95{\%} CI: (0.623–0.757), p < 0.001 in the middle and upper tertiles, in comparison with the lower tertile as a reference, after adjustment for age, sex, the New York Heart Association class, comorbidities, and hospital volume. The same tendency was observed in propensity score analysis using 62,291 (in the lower vs. middle tertile) and 57,228 (in the lower vs. upper tertile) matched pairs (OR: 0.797, 95{\%} CI: 0.725-0.877, p < 0.001 and OR: 0.695, 95{\%} CI: 0.634–0.762, p < 0.001 in the middle and upper tertile, respectively). Conclusions: Higher population density was associated with lower in-hospital mortality in HF. More research is needed to gain insight into causality.",
author = "Masaaki Konishi and Yasushi Matsuzawa and Toshiaki Ebina and Masami Kosuge and Masaomi Gohbara and Kunihiro Nishimura and Michikazu Nakai and Yoshihiro Miyamoto and Yoshihiko Saito and Hiroyuki Tsutsui and Issei Komuro and Hisao Ogawa and Kouichi Tamura and Kazuo Kimura",
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T1 - Impact of population density on mortality in patients hospitalized for heart failure – JROAD-DPC Registry Analysis –

AU - Konishi, Masaaki

AU - Matsuzawa, Yasushi

AU - Ebina, Toshiaki

AU - Kosuge, Masami

AU - Gohbara, Masaomi

AU - Nishimura, Kunihiro

AU - Nakai, Michikazu

AU - Miyamoto, Yoshihiro

AU - Saito, Yoshihiko

AU - Tsutsui, Hiroyuki

AU - Komuro, Issei

AU - Ogawa, Hisao

AU - Tamura, Kouichi

AU - Kimura, Kazuo

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: There is little evidence regarding social and geographic factors in patients with heart failure (HF). We sought to investigate the association between in-hospital mortality of patients with HF and population density of the patients’ area of residence in Japan. Methods: The present study is a retrospective cohort analysis of the nationwide claim-based database, the Japanese Registry Of All cardiac and vascular Diseases-Diagnostic Procedure Combination (JROAD-DPC). We selected data of 196,286 hospitalized patients with HF (median age of 81 years and 51.8% males). Results: In-hospital mortality was 14.2%, 11.8%, and 9.5% in the lower, middle, and upper tertiles of population density, respectively. Age sub-analysis showed the largest absolute rural-urban disparity in mortality was 4.6% in the oldest subgroup (≥80 years). Multivariate analysis using mixed logistic regression model revealed that higher population density was associated with lower in-hospital mortality: multivariable-adjusted odds ratio (OR): 0.785, 95% confidence interval (CI): (0.713–0.864), p < 0.001 and 0.687, 95% CI: (0.623–0.757), p < 0.001 in the middle and upper tertiles, in comparison with the lower tertile as a reference, after adjustment for age, sex, the New York Heart Association class, comorbidities, and hospital volume. The same tendency was observed in propensity score analysis using 62,291 (in the lower vs. middle tertile) and 57,228 (in the lower vs. upper tertile) matched pairs (OR: 0.797, 95% CI: 0.725-0.877, p < 0.001 and OR: 0.695, 95% CI: 0.634–0.762, p < 0.001 in the middle and upper tertile, respectively). Conclusions: Higher population density was associated with lower in-hospital mortality in HF. More research is needed to gain insight into causality.

AB - Background: There is little evidence regarding social and geographic factors in patients with heart failure (HF). We sought to investigate the association between in-hospital mortality of patients with HF and population density of the patients’ area of residence in Japan. Methods: The present study is a retrospective cohort analysis of the nationwide claim-based database, the Japanese Registry Of All cardiac and vascular Diseases-Diagnostic Procedure Combination (JROAD-DPC). We selected data of 196,286 hospitalized patients with HF (median age of 81 years and 51.8% males). Results: In-hospital mortality was 14.2%, 11.8%, and 9.5% in the lower, middle, and upper tertiles of population density, respectively. Age sub-analysis showed the largest absolute rural-urban disparity in mortality was 4.6% in the oldest subgroup (≥80 years). Multivariate analysis using mixed logistic regression model revealed that higher population density was associated with lower in-hospital mortality: multivariable-adjusted odds ratio (OR): 0.785, 95% confidence interval (CI): (0.713–0.864), p < 0.001 and 0.687, 95% CI: (0.623–0.757), p < 0.001 in the middle and upper tertiles, in comparison with the lower tertile as a reference, after adjustment for age, sex, the New York Heart Association class, comorbidities, and hospital volume. The same tendency was observed in propensity score analysis using 62,291 (in the lower vs. middle tertile) and 57,228 (in the lower vs. upper tertile) matched pairs (OR: 0.797, 95% CI: 0.725-0.877, p < 0.001 and OR: 0.695, 95% CI: 0.634–0.762, p < 0.001 in the middle and upper tertile, respectively). Conclusions: Higher population density was associated with lower in-hospital mortality in HF. More research is needed to gain insight into causality.

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