Regional inequalities in heart failure hospitalisation and in-hospital mortality in Spain (2016-2022): a nationwide, observational study

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 organisatio...

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Autores: Ortiz-Cortés, C, Fernández-Friera, L, Gámez, JM, Fillat, AC, Lozano, CB, Sambola, A, Rubio, LF, Padial, LR, Ruiz, RC, Pérez, MP, Hernández, JMD, Rosillo, N, Fernández, SS, del Prado, N, Bernal, JL, Pérez, CF, Alvaredo, D, Rico-Martíin, S, Elola-Somozar, FJ
Formato: artículo
Estado:Versión publicada
Fecha de publicación:2026
País:España
Recursos:INCLIVA
Repositorio:r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
OAI Identifier:oai:incliva.fundanetsuite.com:p20610
Acesso em linha:https://incliva.portalinvestigacion.com/publicaciones/20610
Access Level:acceso abierto
Palavra-chave:Heart failure
Hospitalisation
In-hospital mortality
Regional disparities
Socioeconomic factors
Health determinants
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spelling Regional inequalities in heart failure hospitalisation and in-hospital mortality in Spain (2016-2022): a nationwide, observational studyOrtiz-Cortés, CFernández-Friera, LGámez, JMFillat, ACLozano, CBSambola, ARubio, LFPadial, LRRuiz, RCPérez, MPHernández, JMDRosillo, NFernández, SSdel Prado, NBernal, JLPérez, CFAlvaredo, DRico-Martíin, SElola-Somozar, FJHeart failureHospitalisationIn-hospital mortalityRegional disparitiesSocioeconomic factorsHealth determinantsBackground 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 M & iacute;nimo B & aacute;sico 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.<br /> Findings A total of 764,083 hospitalisations for heart failure were analysed. The mean age of participants was 80.8 +/- 10.6 years. The age-and sex-standardised hospitalisation rate was 255 per 100,000 inhabitants, with significant differences between autonomous communities. Crude in-hospital mortality rate was 11.3% (86,426 episodes), with substantial regional variation in risk-standardised mortality rate (ranged from 7.7% to 16.4%) No associations were found between hospital characteristics and risk-standardised mortality rate at the regional level. Regional health determinants were highly collinear; among all determinants assessed, per-capita gross domestic product was independently associated with lower risk-standardised mortality (beta GDPpc = -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.ELSEVIER2026info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://incliva.portalinvestigacion.com/publicaciones/20610Lancet Regional Health-EuropeISSN: 26667762reponame:r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVAinstname:INCLIVAInglésinfo:eu-repo/semantics/openAccessoai:incliva.fundanetsuite.com:p206102026-06-07T16:35:31Z
dc.title.none.fl_str_mv Regional inequalities in heart failure hospitalisation and in-hospital mortality in Spain (2016-2022): a nationwide, observational study
title Regional inequalities in heart failure hospitalisation and in-hospital mortality in Spain (2016-2022): a nationwide, observational study
spellingShingle Regional inequalities in heart failure hospitalisation and in-hospital mortality in Spain (2016-2022): a nationwide, observational study
Ortiz-Cortés, C
Heart failure
Hospitalisation
In-hospital mortality
Regional disparities
Socioeconomic factors
Health determinants
title_short Regional inequalities in heart failure hospitalisation and in-hospital mortality in Spain (2016-2022): a nationwide, observational study
title_full Regional inequalities in heart failure hospitalisation and in-hospital mortality in Spain (2016-2022): a nationwide, observational study
title_fullStr Regional inequalities in heart failure hospitalisation and in-hospital mortality in Spain (2016-2022): a nationwide, observational study
title_full_unstemmed Regional inequalities in heart failure hospitalisation and in-hospital mortality in Spain (2016-2022): a nationwide, observational study
title_sort Regional inequalities in heart failure hospitalisation and in-hospital mortality in Spain (2016-2022): a nationwide, observational study
dc.creator.none.fl_str_mv Ortiz-Cortés, C
Fernández-Friera, L
Gámez, JM
Fillat, AC
Lozano, CB
Sambola, A
Rubio, LF
Padial, LR
Ruiz, RC
Pérez, MP
Hernández, JMD
Rosillo, N
Fernández, SS
del Prado, N
Bernal, JL
Pérez, CF
Alvaredo, D
Rico-Martíin, S
Elola-Somozar, FJ
author Ortiz-Cortés, C
author_facet Ortiz-Cortés, C
Fernández-Friera, L
Gámez, JM
Fillat, AC
Lozano, CB
Sambola, A
Rubio, LF
Padial, LR
Ruiz, RC
Pérez, MP
Hernández, JMD
Rosillo, N
Fernández, SS
del Prado, N
Bernal, JL
Pérez, CF
Alvaredo, D
Rico-Martíin, S
Elola-Somozar, FJ
author_role author
author2 Fernández-Friera, L
Gámez, JM
Fillat, AC
Lozano, CB
Sambola, A
Rubio, LF
Padial, LR
Ruiz, RC
Pérez, MP
Hernández, JMD
Rosillo, N
Fernández, SS
del Prado, N
Bernal, JL
Pérez, CF
Alvaredo, D
Rico-Martíin, S
Elola-Somozar, FJ
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Heart failure
Hospitalisation
In-hospital mortality
Regional disparities
Socioeconomic factors
Health determinants
topic Heart failure
Hospitalisation
In-hospital mortality
Regional disparities
Socioeconomic factors
Health determinants
description 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 M & iacute;nimo B & aacute;sico 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.<br /> Findings A total of 764,083 hospitalisations for heart failure were analysed. The mean age of participants was 80.8 +/- 10.6 years. The age-and sex-standardised hospitalisation rate was 255 per 100,000 inhabitants, with significant differences between autonomous communities. Crude in-hospital mortality rate was 11.3% (86,426 episodes), with substantial regional variation in risk-standardised mortality rate (ranged from 7.7% to 16.4%) No associations were found between hospital characteristics and risk-standardised mortality rate at the regional level. Regional health determinants were highly collinear; among all determinants assessed, per-capita gross domestic product was independently associated with lower risk-standardised mortality (beta GDPpc = -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.
publishDate 2026
dc.date.none.fl_str_mv 2026
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://incliva.portalinvestigacion.com/publicaciones/20610
url https://incliva.portalinvestigacion.com/publicaciones/20610
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv ELSEVIER
publisher.none.fl_str_mv ELSEVIER
dc.source.none.fl_str_mv Lancet Regional Health-Europe
ISSN: 26667762
reponame:r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
instname:INCLIVA
instname_str INCLIVA
reponame_str r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
collection r-INCLIVA. Repositorio Institucional de Producción Científica de INCLIVA
repository.name.fl_str_mv
repository.mail.fl_str_mv
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