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 organisati...

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Authors: Ortiz-Cortés, Carolina, Fernández-Friera, Leticia, Gámez, José M., Cequier Fillat, Ángel, Bonanad Lozano, Clara, Sambola, Antonia, Fácila Rubio, Lorenzo, Rodríguez Padial, Luis, Campuzano Ruíz, Raquel, Pedreira Pérez, Milagros, Torre Hernández, José María de la|||0000-0003-4570-8902, Rosillo, Nicolás, Sánchez Fernández, Sofía, Prado, Náyade del, Bernal José Luis, Fernández Pérez, Cristina, Alvaredo, Diego, Rico-Martín, Sergio, Elola-Somoza, Francisco
Format: article
Publication Date:2026
Country:España
Institution:Universidad de Cantabria (UC)
Repository:UCrea Repositorio Abierto de la Universidad de Cantabria
Language:English
OAI Identifier:oai:repositorio.unican.es:10902/39420
Online Access:https://hdl.handle.net/10902/39420
Access Level:Open access
Keyword:Heart failure
Hospitalisation
In-hospital mortality
Regional disparities
Socioeconomic factors
Health determinant
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spelling Regional inequalities in heart failure hospitalisation and in-hospital mortality in Spain (2016-2022): a nationwide, observational studyOrtiz-Cortés, CarolinaFernández-Friera, LeticiaGámez, José M.Cequier Fillat, ÁngelBonanad Lozano, ClaraSambola, AntoniaFácila Rubio, LorenzoRodríguez Padial, LuisCampuzano Ruíz, RaquelPedreira Pérez, MilagrosTorre Hernández, José María de la|||0000-0003-4570-8902Rosillo, NicolásSánchez Fernández, SofíaPrado, Náyade delBernal José LuisFernández Pérez, CristinaAlvaredo, DiegoRico-Martín, SergioElola-Somoza, FranciscoHeart failureHospitalisationIn-hospital mortalityRegional disparitiesSocioeconomic factorsHealth determinantBackground: 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: 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 (betaGDPpc = -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).This research was supported by the Spanish Society of Cardiology (SEC) which provided institutional and financial support and contributed to the study conceptionElsevierUniversidad de Cantabria20262026-01-01journal articlehttp://purl.org/coar/resource_type/c_6501NAhttp://purl.org/coar/version/c_be7fb7dd8ff6fe43info:eu-repo/semantics/articlehttps://hdl.handle.net/10902/39420The Lancet Regional Health - Europe, 2026, 61, 101549reponame:UCrea Repositorio Abierto de la Universidad de Cantabriainstname:Universidad de Cantabria (UC)Inglésengopen accesshttp://purl.org/coar/access_right/c_abf2Attribution 4.0 Internationalhttp://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccessoai:repositorio.unican.es:10902/394202026-06-02T12:39:31Z
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, Carolina
Heart failure
Hospitalisation
In-hospital mortality
Regional disparities
Socioeconomic factors
Health determinant
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, Carolina
Fernández-Friera, Leticia
Gámez, José M.
Cequier Fillat, Ángel
Bonanad Lozano, Clara
Sambola, Antonia
Fácila Rubio, Lorenzo
Rodríguez Padial, Luis
Campuzano Ruíz, Raquel
Pedreira Pérez, Milagros
Torre Hernández, José María de la|||0000-0003-4570-8902
Rosillo, Nicolás
Sánchez Fernández, Sofía
Prado, Náyade del
Bernal José Luis
Fernández Pérez, Cristina
Alvaredo, Diego
Rico-Martín, Sergio
Elola-Somoza, Francisco
author Ortiz-Cortés, Carolina
author_facet Ortiz-Cortés, Carolina
Fernández-Friera, Leticia
Gámez, José M.
Cequier Fillat, Ángel
Bonanad Lozano, Clara
Sambola, Antonia
Fácila Rubio, Lorenzo
Rodríguez Padial, Luis
Campuzano Ruíz, Raquel
Pedreira Pérez, Milagros
Torre Hernández, José María de la|||0000-0003-4570-8902
Rosillo, Nicolás
Sánchez Fernández, Sofía
Prado, Náyade del
Bernal José Luis
Fernández Pérez, Cristina
Alvaredo, Diego
Rico-Martín, Sergio
Elola-Somoza, Francisco
author_role author
author2 Fernández-Friera, Leticia
Gámez, José M.
Cequier Fillat, Ángel
Bonanad Lozano, Clara
Sambola, Antonia
Fácila Rubio, Lorenzo
Rodríguez Padial, Luis
Campuzano Ruíz, Raquel
Pedreira Pérez, Milagros
Torre Hernández, José María de la|||0000-0003-4570-8902
Rosillo, Nicolás
Sánchez Fernández, Sofía
Prado, Náyade del
Bernal José Luis
Fernández Pérez, Cristina
Alvaredo, Diego
Rico-Martín, Sergio
Elola-Somoza, Francisco
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.contributor.none.fl_str_mv Universidad de Cantabria
dc.subject.none.fl_str_mv Heart failure
Hospitalisation
In-hospital mortality
Regional disparities
Socioeconomic factors
Health determinant
topic Heart failure
Hospitalisation
In-hospital mortality
Regional disparities
Socioeconomic factors
Health determinant
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 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: 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 (betaGDPpc = -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).
publishDate 2026
dc.date.none.fl_str_mv 2026
2026-01-01
dc.type.none.fl_str_mv journal article
http://purl.org/coar/resource_type/c_6501
NA
http://purl.org/coar/version/c_be7fb7dd8ff6fe43
dc.type.openaire.fl_str_mv info:eu-repo/semantics/article
format article
dc.identifier.none.fl_str_mv https://hdl.handle.net/10902/39420
url https://hdl.handle.net/10902/39420
dc.language.none.fl_str_mv Inglés
eng
language_invalid_str_mv Inglés
language eng
dc.rights.none.fl_str_mv open access
http://purl.org/coar/access_right/c_abf2
Attribution 4.0 International
http://creativecommons.org/licenses/by/4.0/
dc.rights.openaire.fl_str_mv info:eu-repo/semantics/openAccess
rights_invalid_str_mv open access
http://purl.org/coar/access_right/c_abf2
Attribution 4.0 International
http://creativecommons.org/licenses/by/4.0/
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv Elsevier
publisher.none.fl_str_mv Elsevier
dc.source.none.fl_str_mv The Lancet Regional Health - Europe, 2026, 61, 101549
reponame:UCrea Repositorio Abierto de la Universidad de Cantabria
instname:Universidad de Cantabria (UC)
instname_str Universidad de Cantabria (UC)
reponame_str UCrea Repositorio Abierto de la Universidad de Cantabria
collection UCrea Repositorio Abierto de la Universidad de Cantabria
repository.name.fl_str_mv
repository.mail.fl_str_mv
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