SOCIOECONOMIC INEQUITIES IN ACCESS TO GUIDELINE-BASED CARE IN OBSTRUCTIVE HYPERTROPHIC CARDIOMYOPATHY: EVIDENCE FROM GERMAN CLAIMS DATA
Author(s)
Lisa-Marie Müller, MSc1, Maximilian Nicolas Möbius-Winkler, Dr. med.2, Jonas Krampe, Dr. nat.1, Ulrich Laufs, Prof. Dr. med.2, Karsten Lenk, PD. Dr. med.2, Alexander Kogel, Dr. med.2.
1Gesundheitsforen Leipzig GmbH, Leipzig, Germany, 2Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Germany.
1Gesundheitsforen Leipzig GmbH, Leipzig, Germany, 2Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Germany.
OBJECTIVES: Obstructive hypertrophic cardiomyopathy (obstructive HCM) is associated with substantial morbidity and mortality, while real-world evidence on healthcare utilization and socioeconomic disparities remains limited. This study evaluated comorbidity burden, treatment patterns, and determinants of receiving guideline-recommended care (SOC), defined as ≥1 cardiologist visit and prescription of first-line pharmacotherapy per ESC guidelines, in a large German population-based cohort.
METHODS: A retrospective cohort study was conducted using German statutory health insurance claims data from 2014-2023, covering approximately 4.3 million individuals. Patients with obstructive HCM were identified using ICD-10-GM code I42.1 and compared with a 1:10 age- and gender-matched control cohort. Multivariable logistic regression analyses were performed to identify factors potentially associated with the SOC, including individual- and area-based socioeconomic factors, comorbidities, and comedications.
RESULTS: A total of 2,841 patients with obstructive HCM were identified, corresponding to a prevalence of 1:569. Compared with matched controls, patients with obstructive HCM had markedly higher rates of cardiovascular and metabolic comorbidities, including hypertension (88% vs. 66%), coronary artery disease (55% vs. 24%), atrial fibrillation/flutter (39% vs. 16%), and chronic kidney disease (28% vs. 13%) (all p<0.001). Despite this high disease burden, only 57% consulted a cardiologist during the observation period. Beta-blockers were prescribed in 75% and calcium channel blockers in 15% of patients. Socioeconomic disparities significantly influenced care delivery. Living in higher-income areas was strongly associated with receiving SOC (adjusted odds ratio [aOR] 5.74; 95% confidence interval [CI] 3.11-10.59), whereas depression (aOR 0.72; 95%CI 0.65-0.80) and chronic kidney disease (aOR 0.62; 95%CI 0.55-0.69) were negatively associated with SOC.
CONCLUSIONS: Patients with obstructive HCM experience substantial cardiovascular comorbidity but remain undertreated in routine care. Significant socioeconomic disparities in access to guideline-based management persist despite universal healthcare coverage, highlighting the need for targeted outreach strategies and improved referral pathways to ensure equitable specialist access.
METHODS: A retrospective cohort study was conducted using German statutory health insurance claims data from 2014-2023, covering approximately 4.3 million individuals. Patients with obstructive HCM were identified using ICD-10-GM code I42.1 and compared with a 1:10 age- and gender-matched control cohort. Multivariable logistic regression analyses were performed to identify factors potentially associated with the SOC, including individual- and area-based socioeconomic factors, comorbidities, and comedications.
RESULTS: A total of 2,841 patients with obstructive HCM were identified, corresponding to a prevalence of 1:569. Compared with matched controls, patients with obstructive HCM had markedly higher rates of cardiovascular and metabolic comorbidities, including hypertension (88% vs. 66%), coronary artery disease (55% vs. 24%), atrial fibrillation/flutter (39% vs. 16%), and chronic kidney disease (28% vs. 13%) (all p<0.001). Despite this high disease burden, only 57% consulted a cardiologist during the observation period. Beta-blockers were prescribed in 75% and calcium channel blockers in 15% of patients. Socioeconomic disparities significantly influenced care delivery. Living in higher-income areas was strongly associated with receiving SOC (adjusted odds ratio [aOR] 5.74; 95% confidence interval [CI] 3.11-10.59), whereas depression (aOR 0.72; 95%CI 0.65-0.80) and chronic kidney disease (aOR 0.62; 95%CI 0.55-0.69) were negatively associated with SOC.
CONCLUSIONS: Patients with obstructive HCM experience substantial cardiovascular comorbidity but remain undertreated in routine care. Significant socioeconomic disparities in access to guideline-based management persist despite universal healthcare coverage, highlighting the need for targeted outreach strategies and improved referral pathways to ensure equitable specialist access.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EPH56
Topic
Epidemiology & Public Health, Real World Data & Information Systems
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory)