PMID- 35259171 OWN - NLM STAT- MEDLINE DCOM- 20220421 LR - 20220716 IS - 1932-6203 (Electronic) IS - 1932-6203 (Linking) VI - 17 IP - 3 DP - 2022 TI - Is lack of health insurance a predictor of worsening of heart failure among adult patients attending referral hospitals in Northwestern Tanzania? PG - e0264352 LID - 10.1371/journal.pone.0264352 [doi] LID - e0264352 AB - INTRODUCTION: Health insurance coverage is critical for persons living with chronic conditions such as heart failure. Lack of health insurance may affect the ability to access regular healthcare appointments, pay for medication refills which can result in frequent hospitalization that is associated with poor clinical outcomes. In scarce resource locations such as sub-Saharan Africa, where uptake of health insurance is still suboptimal, the effect of health insurance on chronic conditions such as heart failure is poorly understood. The objective of this study was to assess the association of health insurance on the severity of heart failure for patients attending outpatient clinics at tertiary hospitals in Mwanza, Tanzania. METHODS: As part of a larger cohort study, patients with heart failure were recruited from Bugando Medical Center (BMC) and Sekou Toure Regional Hospital (STRH) in Mwanza City, Tanzania. Heart failure was based on Framingham criteria and the severity was determined by New York Heart Association (NYHA) classification. Descriptive analysis and multivariable logistic regression were used to describe the study participants and to assess the association between health insurance status and the severity of heart failure at baseline. RESULTS: 418 patients were enrolled, and majority were female (n = 264, 63%), small scale farmers (n = 278, 66.5%) and were from Mwanza City (n = 299, 71.5%). More than two-thirds of patients did not have health insurance (n = 295, 70.6%) and the majority were in the NYHA I and II classification (n = 267, 64.7%). There was no association between health insurance status and the severity of heart (aOR 0.97; 95% CI 0.84-1.60). Being male, small-scale businessperson and those seen at STRH was associated with higher odds of being in NYHA Class III/IV (aOR = 1.97; 95% CI: 1.21-3.17), (aOR = 2.61; 95% CI: 1.27-5.34) and (aOR 1.91 95% CI: 1.17-3.13) respectively. Having secondary and college education was associated with lower odds of being in Class III/IV (0.42; 95% CI: 0.18-0.98) and (aOR = 0.23 95% CI: 0.06-0.86) respectively. CONCLUSION: In this study, only a third of the patients had health insurance. Health insurance was not associated with the severity of heart failure. Since heart failure is a chronic condition patients who do not have health insurance may incur out of pocket expenses, future research should focus on the effect of out-of-pocket expenditures on clinical outcomes. FAU - Wajanga, Bahati M K AU - Wajanga BMK AUID- ORCID: 0000-0002-1922-0746 AD - Department of Internal Medicine, Bugando Medical Centre, Mwanza, Tanzania. AD - Department of Internal Medicine, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania. FAU - Kim, Christine Yaeree AU - Kim CY AD - Department of Population Health Sciences, Duke University, Durham, NC, United States of America. FAU - Peck, Robert N AU - Peck RN AD - Department of Internal Medicine, Bugando Medical Centre, Mwanza, Tanzania. AD - Department of Internal Medicine, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania. AD - Division of Hospital Medicine, Department of Internal Medicine, Weill Cornell Medical College, New York City, NY, United States of America. AD - Department of Internal Medicine, Center for Global Health, Weill Cornell Medical College, New York City, NY, United States of America. FAU - Bartlett, John AU - Bartlett J AD - Duke Global Health Institute, Durham, NC, United States of America. AD - School of Medicine, Duke University School of Medicine, Durham, NC, United States of America. AD - Kilimanjaro Christian Medical University College, Moshi, Tanzania. FAU - Mabula, Deodatus AU - Mabula D AD - Department of Internal Medicine, Bugando Medical Centre, Mwanza, Tanzania. AD - Department of Internal Medicine, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania. FAU - Juma, Adinan AU - Juma A AD - Kilimanjaro Christian Medical University College, Moshi, Tanzania. FAU - Muiruri, Charles AU - Muiruri C AD - Duke Global Health Institute, Durham, NC, United States of America. AD - School of Medicine, Duke University School of Medicine, Durham, NC, United States of America. AD - Kilimanjaro Christian Medical University College, Moshi, Tanzania. LA - eng GR - D43 TW010138/TW/FIC NIH HHS/United States GR - K01 HL159052/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural DEP - 20220308 PL - United States TA - PLoS One JT - PloS one JID - 101285081 SB - IM MH - Adult MH - Cohort Studies MH - Female MH - *Heart Failure MH - Hospitals MH - Humans MH - Insurance, Health MH - Male MH - Referral and Consultation MH - Tanzania PMC - PMC8903262 COIS- The authors have declared that no competing interests exist. EDAT- 2022/03/09 06:00 MHDA- 2022/04/22 06:00 PMCR- 2022/03/08 CRDT- 2022/03/08 17:11 PHST- 2021/08/31 00:00 [received] PHST- 2022/02/08 00:00 [accepted] PHST- 2022/03/08 17:11 [entrez] PHST- 2022/03/09 06:00 [pubmed] PHST- 2022/04/22 06:00 [medline] PHST- 2022/03/08 00:00 [pmc-release] AID - PONE-D-21-28263 [pii] AID - 10.1371/journal.pone.0264352 [doi] PST - epublish SO - PLoS One. 2022 Mar 8;17(3):e0264352. doi: 10.1371/journal.pone.0264352. eCollection 2022.