Abstract 13560: Household Income Less Than 150% of Federal Poverty Level is Associated With Heart Failure Mortality

Abstract

Introduction: The per capita cost of managing heart failure (HF) is rising and so is the patient’s financial responsibility. This study examined the association between household income expressed as percentage of federal poverty level (FPL) and HF mortality. Methods: The United States Census National Longitudinal Mortality Study (NLMS), consisting of surveys administered between March 1973 and March 2011, was designed to study the effect of socioeconomic factors on mortality rates in the US. Matching the NLMS database to the National Death Index, we identified and retrospectively analyzed data of all cases of heart failure deaths in the NLMS. For this analysis, we included only records that could be prospectively followed for 11 years from time of survey. Study sample was categorized into three groups by baseline household income expressed as a percentage of FPL: Group 1 ≤ 150%FPL (n=1260); 2 >150% but ≤ 300% (n=1059) and 3 > 300% (n=907). We assessed the association between the 3 groups and risk of mortality using unadjusted and adjusted Cox regression. Kaplan Meir plots were computed and survival between the three groups was compared using log-rank statistics. Result: Among the 1,835,072 records that could be followed for 11 years, there were 3,226 HF deaths. Median (IQR) survival (in years) were 5.6 (2.9 – 8.3), 6.2 (3.4 – 8.6) and 6.3 (3.4 – 8.8) for groups 1, 2, and 3 respectively [p=0.002]. Having income less than 150% FPL was associated with 14% increased risk of mortality (hazards ratio [HR]= 1.14 (1.07 – 1.23; P=0.0002) compared with income >150%FPL. Adjusting for age, race, sex, and health insurance status, income less than 150% was independently associated with a 21% higher risk of mortality (HR=1.21 (1.11 – 1.32; p=<.0001)) compared with income >150%FPL. Conclusion: Low income is associated with increased risk of HF mortality. This finding may help guide planning for social interventions and resource allocation.