Neighborhood deprivation factor in racial disparities in 30-day HF readmission
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Black patients living in socioeconomically deprived neighborhoods may represent the most at-risk group for 30-day HF readmission compared with white patients and patients living in less deprived areas, a speaker reported.
According to findings presented at the Heart Failure Society of America Scientific Sessions, CV risk factors and hospital characteristics did not explain the racial disparities in 30-day HF readmission, but the excess risk for 30-day HF readmissions in Black patients was highest in those from the most deprived neighborhoods.
Although hospital systems may strive to reduce disparities in care, longstanding systemic and social inequities may directly contribute to these health care gaps and serve as predictors for HF outcomes, Alanna A. Morris, MD, MSc, FHFSA, assistant professor of medicine at the Emory University Clinical Cardiovascular Research Institute, and a Cardiology Today Next Gen Innovator, said during a presentation.
“Neighborhood socioeconomic status is associated with incident HF and HF readmissions. Race and ethnicity, however, is also closely associated with both individual socioeconomic status, neighborhood socioeconomic status, as well as the risk for HF clinical outcomes, particularly hospitalization,” Morris said. “Our prior work, looking at food desert as a predictor of hospital readmissions shows the patients who live in a food desert had both a higher risk of all-cause as well as HF-specific readmission. Importantly, 84% of the patients who lived in a food desert were Black. if you look at an old map of neighborhoods that were redlined back in the 1930s, in present day almost none of those neighborhoods have a grocery store and only have convenience stores. Our patients who live in neighborhoods that were previously redlined have very few resources compared to patients who live in high socioeconomic status neighborhoods.”
Neighborhood deprivation and HF readmission
For the retrospective analysis, investigators used the Emory Clinical Data Warehouse to build a cohort of 30,630 patients (mean age, 66 years; 48% women; 41% with diabetes) with at least one HF hospitalization between 2010 to 2018 at an Emory Healthcare facility. They used residential addresses for geocoding and stratified them into quartiles of the Social Deprivation Index, using U.S. Census data, to evaluate whether racial disparities in 30-day HF readmission varied by neighborhood socioeconomic status.
Compared with white patients, Black individuals were more likely to be discharged from an internal medicine specialty (34% vs. 61.5%; P < .0001), were less likely to be discharged from a CV specialty (51.9% vs. 26.8%; P < .0001) and had more hospitalizations overall (1.7 vs. 2.4; P < .0001).
After adjustment for sociodemographic characteristics, clinical characteristics and hospital characteristics, Black patients were 45% more likely to be readmitted within 30 days compared with white patients (RR = 1.45; 95% CI, 1.37-1.54).
Moreover, as the quartile of patient neighborhood deprivation increased, so did the adjusted risk difference for 30-day HF readmission between Black patients and white patients (Q1 = 4%; Q2 = 5.5%; Q3 = 8.2%; Q4 = 5.4%).
Informing change
“Does decreasing hospital readmission rate actually do good for a population? Some national data have suggested that decreasing readmission is also associated with an increase in 30-day mortality. Nevertheless, we should consider nonclinical factors such as cognitive function, socioeconomic status and mental health in concert with the clinical data when evaluating our patients,” Keith C. Ferdinand, MD, FACC, FAHA, FASPC, Gerald S. Berenson Chair in Preventative Cardiology and professor of medicine at Tulane University School of Medicine, and a Cardiology Today Editorial Board Member, said in a discussant presentation. “The final implications of this study are important. It does appear that increased HF incident rates are related to living in deprived neighborhoods and it raises important clinical and public health concerns that must be addressed. These findings could serve as an aid to policymakers going forward in terms of allocating resources for primary health care, and it's important looking at these data and others that we target HF patients who reside in deprived neighborhoods before, during and post hospitalization.”
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Patel SA, et al. Late-breaking clinical trials I. Presented at: Heart Failure Society of America Scientific Meeting; Sept. 30-Oct. 6, 2020 (virtual meeting).
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