Racial and Ethnic Differences in Heart Failure Readmissions and Mortality in a Large Municipal Healthcare System

JACC Heart Fail. 2016 Nov;4(11):885-893. doi: 10.1016/j.jchf.2016.05.008. Epub 2016 Jul 6.

Abstract

Objectives: This study sought to determine whether racial and ethnic differences exist among patients with similar access to care. We examined outcomes after heart failure hospitalization within a large municipal health system.

Background: Racial and ethnic disparities in heart failure outcomes are present in administrative data, and one explanation is differential access to care.

Methods: We performed a retrospective cohort study of 8,532 hospitalizations of adults with heart failure at 11 hospitals in New York City from 2007 to 2010. Primary exposure was ethnicity and race, and outcomes were 30- and 90-day readmission and 30-day and 1-year mortality rates. Generalized estimating equations were used to test for associations between ethnicity and race and outcomes with covariate adjustment.

Results: Of the number of hospitalizations included, 4,305 (51%) were for blacks, 2,449 (29%) were for Hispanics, 1,494 (18%) were for whites, and 284 (3%) were for Asians. Compared to whites, blacks and Asians had lower 1-year mortality, with adjusted odds ratios (aORs) of 0.75 (95% confidence interval [CI]: 0.59 to 0.94) and 0.57 (95% CI: 0.38 to 0.85), respectively, and rates for Hispanics were not significantly different (aOR: 0.81; 95% CI: 0.64 to 1.03). Hispanics had higher odds of readmission than whites (aOR: 1.27; 95% CI: 1.03 to 1.57) at 30 (aOR: 1.40; 95% CI: 1.15 to 1.70) and 90 days. Blacks had higher odds of readmission than whites at 90 days (aOR:1.21; 95% CI: 1.01 to 1.47).

Conclusions: Racial and ethnic differences in outcomes after heart failure hospitalization were present within a large municipal health system. Access to a municipal health system may not be sufficient to eliminate disparities in heart failure outcomes.

Keywords: ethnicity; health disparities; heart failure; morbidity; mortality; outcomes research.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • African Americans / statistics & numerical data
  • Aged
  • Aged, 80 and over
  • Asian Americans / statistics & numerical data
  • Cohort Studies
  • Ethnic Groups / statistics & numerical data*
  • European Continental Ancestry Group / statistics & numerical data
  • Female
  • Healthcare Disparities
  • Heart Failure*
  • Hispanic Americans / statistics & numerical data
  • Hospitalization*
  • Humans
  • Male
  • Middle Aged
  • Mortality*
  • New York City
  • Odds Ratio
  • Patient Readmission / statistics & numerical data*
  • Retrospective Studies
  • Young Adult