TY - JOUR
T1 - The Association Between Socioeconomic Status, Sex, Race / Ethnicity and In-Hospital Mortality Among Patients Hospitalized for Heart Failure
AU - Averbuch, T.
AU - Mohamed, M. O.
AU - Islam, S.
AU - Defilippis, E. M.
AU - Breathett, K.
AU - Alkhouli, M. A.
AU - Michos, E. D.
AU - Martin, G. P.
AU - Kontopantelis, E.
AU - Mamas, M. A.
AU - Van Spall, H. G.C.
N1 - Publisher Copyright:
© 2021 Elsevier Inc.
PY - 2022/5
Y1 - 2022/5
N2 - Background: The association between socioeconomic status (SES), sex, race / ethnicity and outcomes during hospitalization for heart failure (HF) has not previously been investigated. Methods and Results: We analyzed HF hospitalizations in the United States National Inpatient Sample between 2015 and 2017. Using a hierarchical, multivariable Poisson regression model to adjust for hospital- and patient-level factors, we assessed the association between SES, sex, and race / ethnicity and all-cause in-hospital mortality. We estimated the direct costs (USD) across SES groups. Among 4,287,478 HF hospitalizations, 40.8% were in high SES, 48.7% in female, and 70.0% in White patients. Relative to these comparators, low SES (homelessness or lowest quartile of median neighborhood income) (relative risk [RR] 1.02, 95% confidence interval [CI] 1.00–1.05) and male sex (RR 1.09, 95% CI 1.07–1.11) were associated with increased risk, whereas Black (RR 0.79, 95% CI 0.76–0.81) and Hispanic (RR 0.90, 95% CI 0.86–0.93) race / ethnicity were associated with a decreased risk of in-hospital mortality (5.1% of all hospitalizations). There were significant interactions between race / ethnicity and both, SES (P < .01) and sex (P = .04), such that racial/ethnic differences in outcome were more pronounced in low SES groups and in male patients. The median direct cost of admission was lower in low vs high SES groups ($9324.60 vs $10,940.40), female vs male patients ($9866.60 vs $10,217.10), and Black vs White patients ($9077.20 vs $10,019.80). The median costs increased with SES in all demographic groups primarily related to greater procedural utilization. Conclusions: SES, sex, and race / ethnicity were independently associated with in-hospital mortality during HF hospitalization, highlighting possible care disparities. Racial/ethnic differences in outcome were more pronounced in low SES groups and in male patients.
AB - Background: The association between socioeconomic status (SES), sex, race / ethnicity and outcomes during hospitalization for heart failure (HF) has not previously been investigated. Methods and Results: We analyzed HF hospitalizations in the United States National Inpatient Sample between 2015 and 2017. Using a hierarchical, multivariable Poisson regression model to adjust for hospital- and patient-level factors, we assessed the association between SES, sex, and race / ethnicity and all-cause in-hospital mortality. We estimated the direct costs (USD) across SES groups. Among 4,287,478 HF hospitalizations, 40.8% were in high SES, 48.7% in female, and 70.0% in White patients. Relative to these comparators, low SES (homelessness or lowest quartile of median neighborhood income) (relative risk [RR] 1.02, 95% confidence interval [CI] 1.00–1.05) and male sex (RR 1.09, 95% CI 1.07–1.11) were associated with increased risk, whereas Black (RR 0.79, 95% CI 0.76–0.81) and Hispanic (RR 0.90, 95% CI 0.86–0.93) race / ethnicity were associated with a decreased risk of in-hospital mortality (5.1% of all hospitalizations). There were significant interactions between race / ethnicity and both, SES (P < .01) and sex (P = .04), such that racial/ethnic differences in outcome were more pronounced in low SES groups and in male patients. The median direct cost of admission was lower in low vs high SES groups ($9324.60 vs $10,940.40), female vs male patients ($9866.60 vs $10,217.10), and Black vs White patients ($9077.20 vs $10,019.80). The median costs increased with SES in all demographic groups primarily related to greater procedural utilization. Conclusions: SES, sex, and race / ethnicity were independently associated with in-hospital mortality during HF hospitalization, highlighting possible care disparities. Racial/ethnic differences in outcome were more pronounced in low SES groups and in male patients.
KW - Heart failure
KW - race
KW - sex
KW - socioeconomic status
UR - https://www.scopus.com/pages/publications/85118863776
UR - https://www.scopus.com/pages/publications/85118863776#tab=citedBy
U2 - 10.1016/j.cardfail.2021.09.012
DO - 10.1016/j.cardfail.2021.09.012
M3 - Article
C2 - 34628014
AN - SCOPUS:85118863776
SN - 1071-9164
VL - 28
SP - 697
EP - 709
JO - Journal of cardiac failure
JF - Journal of cardiac failure
IS - 5
ER -