Regional inequalities in heart failure hospitalisation and in-hospital mortality in Spain (2016–2022): a nationwide, observational study
Year: 2025
Type: article
Study design: Observational Study
Abstract: Background: Heart failure remains one of the leading causes of hospital admissions and mortality worldwide, with substantial regional disparities in clinical outcomes. These variations have been linked to differences in socioeconomic conditions, health determinants, and health-care system organisation. The aim of this study was to analyse regional differences in hospitalisation rates and in-hospital mortality for heart failure across Spain's autonomous communities, and to examine their associations with hospital characteristics and regional health determinants. Methods: We conducted a nationwide, retrospective, population-based study using Spain's national hospital discharge database (Conjunto Mínimo Básico de Datos, CMBD) to identify adults (≥18 years) discharged from public general hospitals within the Spanish National Health System (SNS) with a primary diagnosis of heart failure from January 1, 2016, to December 31, 2022. Differences in hospitalisation rates and risk-standardised in-hospital mortality between autonomous communities were analysed, along with associations with hospital characteristics and regional health determinants. Findings: = -0.77; 95% CI: -1.04 to -0.49; p < 0.001; R2 = 0.77). Interpretation: Significant regional differences in hospitalisation rates and risk-standardised mortality rates were observed among patients hospitalised for heart failure. Regional disparities in gross domestic product per capita may partly explain these differences. These results have clinical and policy implications, underscoring the need to consider socioeconomic determinants when analysing health outcomes and designing public policies aimed at reducing health inequalities. Our findings might be relevant to other European countries with similar public health systems. Funding: This work was supported by the Spanish Society of Cardiology (Sociedad Española de Cardiología, SEC).
Authors: Carolina Ortiz-Cortés, Leticia Fernández-Friera, José M. Gámez, Ángel Cequier Fillat, Clara Bonanad Lozano, Antonia Sambola, Lorenzo Fácila Rubio, Luis Rodríguez Padial, Raquel Campuzano Ruíz, Milagros Pedreira Pérez, José M. de la Torre Hernández, Nicolás Rosillo, Sofía Sánchez Fernández, Náyade del Prado, José Luis Bernal, Cristina Fernández Pérez, Diego Alvaredo, Sergio Rico-Martín, Francisco Javier Elola-Somoza
Institutions: Hospital Universitario Fundación Alcorcón, HM Hospitales, Camilo José Cela University, Instituto de Salud Carlos III, Spanish Biomedical Research Centre in Physiopathology of Obesity and Nutrition, Hospital Son Llatzer, Universitat de les Illes Balears, Institut d'Investigació Biomédica de Bellvitge, Universitat de València, Hospital Clínico Universitario de Valencia, Centro de Investigación en Red en Enfermedades Cardiovasculares, INCLIVA Health Research Institute, Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Hospital General Universitario De Valencia, Complejo Hospitalario Universitario de Toledo, Hospital Universitario de Toledo, Complejo Hospitalario Universitario de Santiago, Marqués de Valdecilla University Hospital, Instituto de Investigación Marqués de Valdecilla, Universidad Rey Juan Carlos, Fundación Instituto para la Mejora de la Asistencia Sanitaria, Universidade de Santiago de Compostela, Instituto de Investigación Sanitaria de Santiago, Universidad de Extremadura
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $4,930
Funder: Sociedad Española de Cardiología
OpenAlex ID: W4416917706