Racial and Ethnic Differences in Trajectories of Hospitalization in US Men and Women With Heart Failure

Abstract

BackgroundPrior studies have documented racial and ethnic disparities in hospitalization among patients with heart failure (HF). However, racial/ethnic differences in trajectories of hospitalization following the diagnosis of HF have not been well characterized. This study examined racial/ethnic differences in individual‐level trajectories of hospitalization in older adults with diagnosed HF.Methods and ResultsData from a nationally representative prospective cohort of US men and women aged 45 years and older were used to examine the number of hospitalizations reported every 24 months. Participants who were non‐Hispanic white, non‐Hispanic black, and Hispanic with a reported diagnosis of HF (n=3011) were followed from 1998 to 2014. Results showed a quadratic change in the number of reported hospitalizations following HF diagnosis, with an average of 2.36 (95% confidence interval [CI], 2.19–2.53; P<0.001) hospitalizations within 24 months that decreased by 0.35 (95% CI, −0.45 to −0.25; P<0.001) every 24 months and subsequently increased by 0.03 (95% CI, 0.02–0.05; P<0.001) thereafter. In men, there were no racial/ethnic differences in hospitalizations reported at the time of diagnosis; however, Hispanic men had significant declines in hospitalizations after diagnosis (Hispanic×time=−0.52; 95% CI, −0.99 to −0.05 [P=0.031]) followed by a sizeable increase in hospitalizations at later stages of disease (Hispanic×time2=0.06; 95% CI, 0.00–0.12 [P=0.047]). In women, hospitalizations were consistently high following their diagnosis and black women had significantly more hospitalizations throughout follow‐up than white women (black=0.28; 95% CI, 0.00–0.55 [P=0.048]). Racial/ethnic disparities varied by geography and the differences remained significant after adjusting for multiple sociodemographic, psychosocial, behavioral, and physiological factors.ConclusionsThere were significant racial/ethnic differences in trajectories of hospitalization following the diagnosis of HF in US men and women. Racial/ethnic disparities varied by place of residence and the differences persisted after adjustment for multiple risk factors. The findings have important implications that may be crucial to planning the immediate and long‐term delivery of care in patients with HF to reduce potentially preventable hospitalizations.

Heart Disease and Stroke Statistics—2022 Update: A Report From the American Heart Association

“…Data from the Health and Retirement Study from 1998 to 2014 show racial and ethnic differences in hospitalization trajectories over 24 months after HF diagnosis. 87 Compared with NH males, Hispanic males have declines in hospitalization rates after initial diagnosis (Hispanic×time, −0.52 [95% CI, −0.99 to −0.05]) but increases in hospitalizations in later stages of disease (Hispanic×time 2 , 0.06 [95% CI, 0.00–0.12]). Among females, Black individuals had significantly more hospitalizations throughout the follow-up period compared with other groups (5.8 total hospitalizations in Black individuals versus 4.7 in White individuals versus 4.7 in Hispanic individuals; unadjusted P for ANOVA across all race groups <0.001).…”

Cardiometabolic risk factor control in black and white people in the United States initiating sodium‐glucose co‐transporter‐2 inhibitors: A real‐world study

“…Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of morbidity and mortality globally, particularly in people with type 2 diabetes. [1][2][3] In the general US population, studies have reported persistent racial and ethnic differences in cardiovascular morbidity and mortality, 4,5 with the higher prevalence of cardiometabolic risk factors reflecting the earlier age of onset of cardiovascular diseases among black people compared to white people. 6,7 However, among people with diabetes, there is conflicting evidence about whether black people have an increased risk of cardiovascular disease.…”

Association of race and gender with primary caregiver relationships and eligibility for advanced heart failure therapies

“…Black women in our cohort were particularly less likely to be eligible for advanced therapies, and since they more frequently identified non‐spousal caregivers, it is possible that implicit bias may have been present during our evaluation process. Black patients being evaluated for advanced HF therapies may not necessarily fit a “traditional” family framework, as Black individuals are less likely to be married compared to other race‐ethnic groups, and may be more likely to rely on help from multiple family members including those outside of the home 22,23 . As Black patients often present at a later stage of illness than non‐Black patients, providers’ assumptions regarding increased requirements of social support, combined with a non‐traditional family support plan, may disadvantage Black patients undergoing evaluation.…”