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Nicklas Vinter

Social determinants of health and catheter ablation after an incident diagnosis of atrial fibrillation: A Danish nationwide cohort study

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  • Nicklas Vinter
  • Peter Calvert, University of Liverpool
  • ,
  • Mads Brix Kronborg
  • Jens Cosedis-Nielsen
  • Dhiraj Gupta, University of Liverpool
  • ,
  • Wern Yew Ding, University of Liverpool
  • ,
  • Ludovic Trinquart, Tufts University
  • ,
  • Søren Paaske Johnsen, Aalborg University
  • ,
  • Lars Frost
  • Gregory Y H Lip, University of Liverpool, Aalborg University

AIMS: To examine (i) the sex-specific associations between three social determinants of health (SDOH) and use of ablation after incident atrial fibrillation (AF), and (ii) the temporal trends in these associations.

METHODS AND RESULTS: We conducted a nationwide cohort study of patients with an incident hospital diagnosis of AF between 2005 and 2018. SDOH at the time of AF diagnosis included three levels of educational attainment, tertile groups of family income, and whether the patient was living alone. Outcome was catheter ablation for AF. We used cause-specific proportional hazard models to estimate hazard ratios (HR) with 95% CI and adjusted for age. To examine temporal trends, we included an interaction term between the exposure and calendar years. Among 122 276 men, those with lower education [HR 0.49 (95%CI 0.45-0.53)] and 0.72 (0.68-0.77) for lower and medium vs. higher], lower income [HR 0.31 (0.27-0.34) and 0.56 (0.52-0.60) for lower and medium vs. higher], and who lived alone [HR 0.60 (0.55-0.64)] were less likely to receive AF ablation. Among 98 476 women, those with lower education [HR 0.45 (0.40-0.50) and 0.83 (0.75-0.91) for lower and medium vs. higher], lower income [HR 0.34 (0.28-0.40) and 0.51 (0.46-0.58) for lower and medium vs. higher], and who lived alone [HR 0.67 (0.61-0.74)] were less likely to receive AF ablation. We found no evidence of temporal trends in the associations.

CONCLUSION: In the Danish universal healthcare system, patients with AF who had lower educational attainment, lower family income, or were living alone were less likely to undergo AF ablation.

Original languageEnglish
JournalEuropean heart journal. Quality of care & clinical outcomes
Pages (from-to)389–396
Number of pages8
Publication statusPublished - Jun 2023

    Research areas

  • Atrial Fibrillation/diagnosis, Catheter Ablation, Cohort Studies, Denmark/epidemiology, Female, Humans, Male, Risk Factors, Social Determinants of Health

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