Background:

Research shows that areas with high socioeconomic deprivation and rural characteristics are linked to higher mortality rates of age associated cardiovascular diseases like heart failure (HF), acute myocardial infarction (AMI) or stroke. However, few studies have examined these characteristics in combination, particularly at the community level.

Aim of the study:

This study aims to analyze whether regional socioeconomic deprivation and rurality affect mortality rates, specifically one-year survival in patients with cardiovascular disease.

Methodology:

This secondary data analysis uses health insurance data (Knappschaft Bahn-See) to assess one-year survival in patients hospitalized for HF, AMI, or stroke. Patient data were linked to the German socioeconomic deprivation index (GISD, RKI) and rurality data (proxy: population density, INKAR) and anonymized. After providing a descriptive summary of the outcome (one-year survival) and covariates, Kaplan-Meier analysis and Cox proportional hazards regression models were applied. Additionally to the analyses of the whole sample (overall and separately for HI, AMI and stroke), propensity score matched analysis (high vs. low GISD) was performed.

Results:

Between 2012 and 2020, a total of 114,119 cases, corresponding to 107,271 patients, were included in this analysis. In the cox regression analysis, after adjusting for covariates such as age, gender, family status and living situation (model 2), no associations were found in the whole population, nor in the HI and stroke subgroups. A high spatial socioeconomic deprivation was associated with increased one-year survival in patients with AMI (HR 1.11, 95% CI: 1.03–1.19). The effect was stable after considering rurality in the model (model 3). These observations could be reproduced after propensity score matching.

Conclusions:

While all three cardiovascular diseases were considered, in-depth analysis will focus specifically on AMI. Future analyses will explore the role of GISD and rurality associated infrastructure parameters.