Clinical Investigation
Congestive Heart Failure
Housing conditions and mortality in older patients hospitalized for heart failure

https://doi.org/10.1016/j.ahj.2011.03.002Get rights and content

Background

Although decent housing is recognized as a prerequisite for good health, very few studies in developed countries have examined the influence of housing characteristics on disease prognosis. This work examined whether housing conditions predict mortality in older adults with heart failure (HF).

Methods

This is a cohort study comprising 433 patients hospitalized for HF-related emergencies in 4 Spanish hospitals between January 1, 2000, and June 30, 2001. At baseline, patients reported whether their homes lacked an elevator (in an apartment building), hot water, heating, an indoor bathroom, a bathtub or shower, individual bedroom, automatic washing machine, and telephone and whether they frequently felt cold. Analyses included all-cause deaths identified prospectively until January 1, 2005.

Results

Among study participants, 165 (38.1%) lived in a home without one of the services considered; and 111 (25.6%) lacked ≥2 services. During follow-up, 260 deaths (60%) occurred. After adjustment for the main confounders, mortality was higher in those who lived in homes without an elevator (hazard ratio [HR] 1.39, 95% CI 1.07-1.80) and in those who frequently felt cold (HR 1.39, 95% CI 1.01-1.92). In comparison with living in a home with all the services considered, mortality was higher for persons living in a home lacking 1 service (HR 1.42, 95% CI 1.10-1.93) or ≥2 services (HR 1.94, 95% CI 1.37-2.74). Patients living in homes lacking any of the services more often had poor functional status, higher comorbidity, lower educational level, and less income.

Conclusion

Poor housing conditions are associated with higher mortality in HF. Patients living in these homes are especially vulnerable because they have poorer clinical situation and lower socioeconomic position.

Section snippets

Background

Since the 19th century, it has been recognized that decent housing is a prerequisite for a healthy life.1 Although this idea was born in a period of miserable living conditions for most of the population, recent evidence shows that housing characteristics continue to be important for health in the developed countries. For example, poor living conditions in the general population are associated with higher mortality from cardiovascular and respiratory diseases, cancer, and all causes.2, 3, 4, 5

Study design and patients

The study methods have been reported previously.13, 14 Briefly, we studied 433 patients hospitalized for HF-related emergencies in 4 Spanish hospitals between January 1, 2000, and June 30, 2001. These patients were followed up prospectively, and all-cause deaths registered until January 1, 2005 were included in the analyses.

We included patients aged 65 years and older with a diagnosis (principal or secondary) of suspected HF in the emergency department. Confirmation of the HF diagnosis was made

At baseline

Of the 433 study participants, 203 (47%) lived in an apartment building without an elevator; 102 (23.6%) lived in a home without heating; 73 (17.9%) felt frequently cold; and 28 (6.5%) did not have an individual bedroom. Only 2% to 4% of subjects lacked a telephone, hot running water, bathtub or shower, indoor bathroom, or automatic washing machine. A total of 165 persons (38.1%) lived in homes lacking one of the previous services, and 111 persons (25.6%) lacked ≥2 services.

In comparison with

Discussion

Our results show that poor housing conditions are associated with higher mortality in older adults hospitalized for HF. Lacking an elevator in an apartment building and frequently feeling cold are the specific characteristics associated with higher mortality. This association is independent of numerous potential confounders, including socioeconomic position.

Various mechanisms can explain the association between lacking an elevator in an apartment building and the higher mortality in patients

Conclusion

Worse housing conditions, particularly lack of an elevator in apartment buildings and frequently feeling cold, are associated with higher mortality in patients with HF. Moreover, patients with poorer housing conditions have worse functional status and greater comorbidity, which makes them even more vulnerable.

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