Low Socioeconomic Status Is Associated with Reduced Access to Natriuretic Peptide Testing in the Outpatient Setting: A Population-based Evaluation
Bibliographic record
Abstract
Background Tests of natriuretic peptide (NP) concentrations are guideline-recommended for diagnosis and prognostication in heart failure (HF). Although NP testing is available at some hospitals, outpatient access has been limited to those who can pay out-of-pocket. We investigated whether residents who have lower socioeconomic status have differential access to NP testing. Methods Using a case-control design, we compared patients who had NP tests with age-matched patients undergoing non-NP blood tests (January 2015-June 2020), performed in the outpatient or acute hospital setting. The association of socioeconomic status measures (eg, deprivation quintile) with receipt of NP testing was assessed using conditional logistic regression, adjusted for sex, test location, and comorbidities, and was stratified by incidence of prior HF. Results Among 96,919 patients without prior HF (median age, 72 years; 50% female) who underwent NP testing, the majority of tests (66.6%) were performed in an acute hospital setting rather than in an outpatient clinic. Residents of more-deprived neighbourhoods had a higher incidence of HF ( P < 0.001), but they were more likely to undergo NP testing in an acute care setting (odds ratio [OR] for most- vs least-deprived, 1.269; 95% confidence interval [CI], 1.104-1.216) and less likely to undergo testing as outpatients (OR, 0.807; 95% CI, 0.764-0.853 vs least-deprived; all P < 0.001). Among 70,362 matched patients with known HF (median aged, 78 years; 45% female), outpatient NP testing was also less likely to be performed among patients living in the most-deprived neighbourhoods (OR, 0.723; 95% CI, 0.677-0.772; P < 0.001). Conclusions Although those of lower socioeconomic status exhibit a higher risk of incident HF, they had less NP testing performed in outpatient settings, and more testing performed in resource-intense acute-care settings.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".