Abstract
Abstract 12969: Community-Level Socioeconomic Distress, Race, and Risk of Adverse Outcomes Following Heart Failure Hospitalization Among Medicare Beneficiaries
Circulation (New York, N.Y.), Vol.144(Suppl_1), p.A12969
11/16/2021
DOI: 10.1161/circ.144.suppl_1.12969
Abstract
Background:
Socioeconomic (SE) disadvantage is a strong determinant of adverse outcomes in patients with HF. The contribution of SE disparities to adverse outcomes in HF may differ among Black vs. White patients and has not been well studied.
Methods:
Using the 100% CMS MedPAR data, Black and White patients hospitalized with HF between 2014 and 2017 were identified and stratified based on the distressed community index (DCI)—a measure of the SE disadvantage of residential ZIP codes on a continuous scale (range 0-100, see Fig. legend)—into two groups: SE distressed (Q5) vs. non-distressed (Q1-4). The rates of 30-day and 1-year mortality and readmission were compared across the distressed vs. non-distressed race groups. The adjusted association between DCI and risk of adverse outcomes was assessed separately across the race groups using adjusted hierarchical logistic regression models with restricted cubic splines.
Results:
The study included 1,238,537 White (14.8% distressed) and 190,721 Black (44.4% distressed) patients. White patients living in SE distressed communities had a significantly higher risk of adverse outcomes at 30-days and 1-year f/u (Fig. A). In contrast, among Black patients, the risk of adverse outcomes among those living in distressed vs. non-distressed communities were not meaningfully different at 30-days and became more prominent by 1-year f/u. Similar results were noted in the restricted cubic spline analysis with stronger and more graded association between DCI score and risk of adverse outcomes in White (vs. Black) patients (Fig. B).
Conclusion:
SE distress is strongly associated with risk of adverse outcomes in White patients with HF. Among Black patients, SE distress is more common, but its adverse effects are less evident during short-term f/u and are better highlighted in the long-term. Other societal factors such as structural racism and poor access to care may be important prognostic determinants in Black patients with HF.
Details
- Title: Subtitle
- Abstract 12969: Community-Level Socioeconomic Distress, Race, and Risk of Adverse Outcomes Following Heart Failure Hospitalization Among Medicare Beneficiaries
- Creators
- Amgad Mentias - Cleveland ClinicMary S Vaughan Sarrazin - University of IowaShreya Rao - UTSW, Dallas, TXMilind Y Desai - Cleveland, OHAlanna A Morris - Emory University School of MedicineJennifer Hall - AHA, Dallas, TXVenu Menon - Cleveland ClinicClyde YancyMario Sims - University of MississippiAlana A Lewis - Northwestern MedicineGregg C Fonarow - Ronald Reagan UCLA Medical CenterSaket Girotra - University of IowaAmbarish Pandey
- Resource Type
- Abstract
- Publication Details
- Circulation (New York, N.Y.), Vol.144(Suppl_1), p.A12969
- DOI
- 10.1161/circ.144.suppl_1.12969
- ISSN
- 0009-7322
- eISSN
- 1524-4539
- Language
- English
- Date published
- 11/16/2021
- Academic Unit
- Cardiovascular Medicine; General Internal Medicine; Internal Medicine; Health Management and Policy
- Record Identifier
- 9984363548002771
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