Health Disparities in Patients with Congestive Heart Failure Exacerbations in Los Angeles County

Emerg Med Investig. 2018;6(2):176. doi: 10.29011/2475-5605.000076. Epub 2018 Jun 20.


Background: 1.1.Congestive Heart Failure (CHF) is a leading cause of death in the USA, with over 500,000 new cases diagnosed each year. While rates of CHF exacerbation across all races and ethnicities decreased from 2005 to 2009, the number of Black patients with CHF exacerbation who present in Los Angeles (L. A.) County Emergency Departments (ED) remained the highest. We examine disparities in CHF exacerbation rates in L. A. County, and in Los Angeles Service Planning Area (SPA) 6, and compare CHF-related outcomes, and the disposition of these patients post-ED visit.

Methods: 1.2.This is a retrospective analysis using the Office of Statewide Health Planning and Development (OSHPD) Emergency Department, and Ambulatory Surgery Center database from 2005 to 2009. We used the following variables: congestive heart failure, ICD-9 code 428.0, age, gender, race/ethnicity, insurance status, and disposition. Univariate and descriptive statistics identified distributions of the study variables. There were a total of 13,766 in the study population.

Results: 1.3.SPA 6 had higher hospitalization rates across all races and ethnicities, compared to L.A. County as a whole. Blacks constitute 9.1% of the County population, but represented 32% of patients diagnosed with CHF in the ED. Only about 10% of L. A. County's population resides in SPA 6, yet over 22% of the entire County's CHF patients reside there.

Conclusions: 1.4.CHF continues to disproportionately affect Black individuals in L.A. County, and younger adults in SPA 6. Our results indicate that residing in this service planning area, in addition to race, can predict greater likelihood of presenting with CHF exacerbation in the ED, and greater likelihood of hospitalization. Future research on the association of CHF exacerbation with different sociodemographic measures among minority, underserved and disadvantaged patients is needed. These can identify and help mitigate inequities and weaknesses in our health care system, which are manifest through stark health disparities among different racial, ethnic and socioeconomic groups.

Keywords: CHF Exacerbation; Congestive Heart Failure; Emergency Department; Health Disparities; Hospitalization; Race.