Journal article
Community-Level Economic Distress, Race, and Risk of Adverse Outcomes After Heart Failure Hospitalization Among Medicare Beneficiaries
Circulation (New York, N.Y.), Vol.145(2), pp.110-121
01/11/2022
DOI: 10.1161/CIRCULATIONAHA.121.057756
PMCID: PMC9172990
PMID: 34743555
Abstract
Socioeconomic disadvantage is a strong determinant of adverse outcomes in patients with heart failure. However, the contribution of community-level economic distress to adverse outcomes in heart failure may differ across races and ethnicities.
Patients of self-reported Black, White, and Hispanic race and ethnicity hospitalized with heart failure between 2014 and 2019 were identified from the Medicare MedPAR Part A 100% Files. We used patient-level residential ZIP code to quantify community-level economic distress on the basis of the Distressed Community Index (quintile 5: economically distressed versus quintiles 1-4: nondistressed). The association of continuous and categorical measures (distressed versus nondistressed) of Distressed Community Index with 30-day, 6-month, and 1-year risk-adjusted mortality, readmission burden, and home time were assessed separately by race and ethnicity groups.
The study included 1 611 586 White (13.2% economically distressed), 205 840 Black (50.6% economically distressed), and 89 199 Hispanic (27.3% economically distressed) patients. Among White patients, living in economically distressed (versus nondistressed) communities was significantly associated with a higher risk of adverse outcomes at 30-day and 1-year follow-up. Among Black and Hispanic patients, the risk of adverse outcomes associated with living in distressed versus nondistressed communities was not meaningfully different at 30 days and became more prominent by 1-year follow-up. Similarly, in the restricted cubic spline analysis, a stronger and more graded association was observed between Distressed Community Index score and risk of adverse outcomes in White patients (versus Black and Hispanic patients). Furthermore, the association between community-level economic distress and risk of adverse outcomes for Black patients differed in rural versus urban areas. Living in economically distressed communities was significantly associated with a higher risk of mortality and lower home time at 1-year follow-up in rural areas but not urban areas.
The association between community-level economic distress and risk of adverse outcomes differs across race and ethnic groups, with a stronger association noted in White patients at short- and long-term follow-up. Among Black patients, the association of community-level economic distress with a higher risk of adverse outcomes is less evident in the short term and is more robust and significant in the long-term follow-up and rural areas.
Details
- Title: Subtitle
- Community-Level Economic Distress, Race, and Risk of Adverse Outcomes After Heart Failure Hospitalization Among Medicare Beneficiaries
- Creators
- Amgad Mentias - Cleveland ClinicMilind Y Desai - Cleveland ClinicMary S Vaughan-Sarrazin - Veterans Health AdministrationShreya Rao - The University of Texas Southwestern Medical CenterAlanna A Morris - Emory UniversityJennifer L Hall - American Heart AssociationVenu Menon - Cleveland ClinicJason Hockenberry - Department of Public Health (Health Policy), Yale School of Public Health, New Haven, CT (J.H.).Mario Sims - University of Mississippi Medical CenterGregg C Fonarow - Ronald Reagan UCLA Medical CenterSaket Girotra - Veterans Health AdministrationAmbarish Pandey - The University of Texas Southwestern Medical Center
- Resource Type
- Journal article
- Publication Details
- Circulation (New York, N.Y.), Vol.145(2), pp.110-121
- DOI
- 10.1161/CIRCULATIONAHA.121.057756
- PMID
- 34743555
- PMCID
- PMC9172990
- ISSN
- 1524-4539
- eISSN
- 1524-4539
- Grant note
- R03 AG067960 / NIA NIH HHS
- Language
- English
- Date published
- 01/11/2022
- Academic Unit
- Health Management and Policy; Cardiovascular Medicine; General Internal Medicine; Internal Medicine
- Record Identifier
- 9984359904002771
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