Low educational level increases functional disability risk subsequent to heart failure in Japan: On behalf of the Iwate KENCO study group

PLoS One. 2021 Jun 8;16(6):e0253017. doi: 10.1371/journal.pone.0253017. eCollection 2021.


Objectives: The risk factors that contribute to future functional disability after heart failure (HF) are poorly understood. The aim of this study was to determine potential risk factors to future functional disability after HF in the general older adult population in Japan.

Methods: The subjects who were community-dwelling older adults aged 65 or older without a history of cardiovascular diseases and functional disability were followed in this prospective study for 11 years. Two case groups were determined from the 4,644 subjects: no long-term care insurance (LTCI) after HF (n = 52) and LTCI after HF (n = 44). We selected the controls by randomly matching each case of HF with three of the remaining 4,548 subjects who were event-free during the period: those with no LTCI and no HF with age +/-1 years and of the same sex, control for the no LTCI after HF group (n = 156), and control for the LTCI after HF group (n = 132). HF was diagnosed according to the Framingham diagnostic criteria. Individuals with a functional disability were those who had been newly certified by the LTCI during the observation period. Objective data including blood samples and several socioeconomic items in the baseline survey were assessed using a self-reported questionnaire.

Results: Significantly associated risk factors were lower educational levels (odds ratio (OR) [95% confidence interval (CI)]: 3.72 [1.63-8.48]) in the LTCI after HF group and hypertension (2.20 [1.10-4.43]) in no LTCI after HF group. Regular alcohol consumption and unmarried status were marginally significantly associated with LTCI after HF (OR [95% CI]; drinker = 2.69 [0.95-7.66]; P = 0.063; unmarried status = 2.54 [0.91-7.15]; P = 0.076).

Conclusion: Preventive measures must be taken to protect older adults with unfavorable social factors from disability after HF via a multidisciplinary approach.

Grant support

This work was supported by JSPS KAKENHI grant numbers JP17K09126 (KT), JP16KT0009 (KT), and JP20K18858 (ST). This research was also supported by a grant-in-aid from the Ministry of Health, Labour and Welfare, Health and Labour Sciences Research Grants, Japan (Comprehensive Research on Cardiovascular Disease and Life-Related Disease: H23-Junkankitou [Seishuu]-Ippan-005 (SK); H26-Junkankitou [Seisaku]-Ippan-001 (SK), H29-Junkankitou-Ippan-003 (SK), and 20FA1002 (SK)). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.