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

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.