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Public Health


Bin Cai


Rheumatic heart disease (RHD) is the major cause of acquired heart disease and death for children and young adults in developing countries. Poverty and social disadvantage are thought to influence the clinical outcomes in RHD patients. Guided by the health lifestyle theory, this study assessed the relationship between socioeconomic status and clinical outcomes (heart failure events and mortality) in patients with RHD. It also examined how adherence to penicillin prophylaxis mediates the effect of socioeconomic status (SES) on clinical outcomes. Using the Nigerian database of the REMEDY study, this study was conducted with 243 participants using Poisson regression and logistic regression models. There was statistically significant association between SES and heart failure events (OR=4.77, 95% CI=1.07-21.32, p=0.04). There was no significant association seen between SES and mortality. Penicillin adherence was not a significant mediatory variable in the relationship between SES and heart failure event and between SES and mortality. These findings are consistent with studies showing low SES is a potential factor for increased risk of recurrent heart failure events in RHD patients. It is however at variance with studies that showed an increased risk of heart failure and mortality in patients with poor adherence to penicillin prophylaxis. A positive social change implication might be the need for physicians treating symptomatic patients with RHD to develop specific strategies for patients from lower SES in order to reduce the recurrence of heart failure. Future studies incorporating a composite measure of SES especially that using income as proxy is needed to further improve our understanding of the role of SES in clinical outcomes

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