Socioeconomic and Clinical Predictors of Mortality in Patients with Acute Dyspnea

Abstract

Torgny Wessman,1,2 Rafid Tofik,1,2 Thoralph Ruge,1,2 Olle Melander2,3 1Department of Emergency Medicine, Skåne University Hospital, Malmö, Sweden; 2Department of Clinical Sciences, Lund University, Malmö, Sweden; 3Department of Internal Medicine, Skåne University Hospital, Malmö, SwedenCorrespondence: Torgny WessmanDepartment of Emergency Medicine, University Hospital of Skåne, Malmö, SwedenEmail [email protected]: Factors predicting long-term prognosis in patients with acute dyspnea may guide both acute management and follow-up. The aim of this study was to identify socioeconomic and clinical risk factors for all-cause mortality among acute dyspnea patients admitted to an Emergency Department.Methods: We included 798 patients with acute dyspnea admitted to the ED of Skåne University Hospital, Malmö, Sweden from 2013 to 2016. Exposures were living in the immigrant-dense urban part of Malmö (IDUD), country of birth, annual income, comorbidities, smoking habits, medical triage priority and severity of dyspnea. Mean follow-up time was 2.2 years. Exposures were related to risk of all-cause mortality using Cox proportional hazard model.Results: During follow-up 40% died. In models adjusted for age and gender, low annual income, previous or ongoing smoking, certain comorbidities, high medical triage priority and severe dyspnea were all significantly associated with increased mortality. After adjusting for age, gender and all significant exposures, the lowest quintile of income, ongoing or previous smoking, history of serious infection, anemia, hip fracture, high medical triage priority and severe dyspnea significantly and independently predicted mortality. In contrast, neither country of birth nor living in IDUD predicted a mortality risk.Conclusion: Apart from several clinical risk factors, low annual income predicts two-year mortality risk in patients with acute dyspnea. This is not the case for country of birth and living in IDUD. Our results underline the wide range of mortality risk factors in acute dyspnea patients. Knowledge of patients’ annual income as well as certain clinical features may aid risk stratification and determining the need of follow-up both in hospital and after discharge from an ED.Keywords: acute dyspnea, emergency department, risk factor, immigrant, smoking, socioeconomic status, mortality, comorbidity, METTS

Keywords

• acute dyspnea
• emergency department
• risk factor
• immigrant
• smoking
• socioeconomic status
• mortality
• comorbidity
• metts.