In HF, link between economic distress, poor outcomes varies by race, ethnicity
In patients with HF, the relationship between community-level economic distress and adverse clinical outcomes varies by race and ethnicity, according to findings presented at the American Heart Association Scientific Sessions.
Amgad Mentias, MD, MSc, assistant professor and clinical cardiologist in the Tomsich Family Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular & Thoracic Institute at Cleveland Clinic, and colleagues analyzed patients appearing in the CMS Medicare Provider Analysis and Review (MEDPAR) database who were hospitalized for HF from 2014 to 2019. The cohort included 1,611,586 white patients (13.2% from economically distressed areas), 205,840 Black patients (50.6% from economically distressed areas) and 89,199 Hispanic patients (27.3% from economically distressed areas).
“Community-level economic distress is an important determinant of outcomes in patients with heart failure,” Ambarish Pandey, MD, MSCS, FAHA, assistant professor of internal medicine, Texas Health Resources Clinical Scholar and associate program director for residency training in the division of cardiology at UT Southwestern Medical Center, told Healio. “How the contribution of community-level socioeconomic distress toward the risk of adverse outcomes may differ by race/ethnicity and geographic location (urban vs. rural) of patients is not well known. We conducted this study to address this knowledge gap by, first, assessing the burden of community-level socioeconomic distress and, second, evaluating the association of community-level economic distress with the risk of adverse outcomes among HF patients of different races and across rural vs. urban regions.”
Burden of community-level economic distress
In the overall cohort, community-level economic distress was associated with elevated risk for 30-day mortality after HF hospitalization, according to the researchers.
For white patients, risk-adjusted 30-day mortality was higher in those in economically distressed communities than in those in nondistressed communities, as was risk-adjusted 1-year mortality (P < .001 for both), Mentias and colleagues found.
However, risk-adjusted 30-day mortality in Black patients did not significantly differ according to community-level economic distress (P = .052), though risk-adjusted 1-year mortality did (P < .001), whereas in Hispanic patients, there was no relationship between community-level economic distress and mortality at any time, according to the researchers.
When community-level economic distress was analyzed as a continuous variable, there was a stronger relationship between it and mortality for white patients than Black patients at any time point (P for interaction for 30-day mortality < .001; P for interaction for 1-year mortality = .02), according to the researchers.
The relationship between community-level economic distress and readmission rates varied in white and Black patients similarly to the relationship community-level economic distress and mortality. In Hispanic patients, there were no significant associations between community-level economic distress and readmission rates at 30 days and 1 year, according to the researchers.
“In addition to community-level socioeconomic distress, geographical proximity to resources (urban vs. rural) was also an important determinant of outcomes in patients with HF,” Pandey told Healio. “Patients living in distressed rural communities had the highest mortality rates across both race groups, significantly higher than patients living in distressed urban communities. Moreover, the mortality rates in nondistressed rural communities were comparable to that of distressed urban communities.”
The results were published in Circulation.
‘Complex interplay’
Pandey said the results reinforce that addressing community-level socioeconomic distress is important.
“Our study highlights the complex interplay of community-level socioeconomic distress, geographical proximity to resources and race for clinical outcomes in patients with heart failure,” Pandey told Healio. “Health policies targeting improvements in community-level economic distress and access to care are key to improving outcomes and reducing racial disparities among patients with heart failure.”
Reference:
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Mentias A, et al. Presentation 183. Presented at: American Heart Association Scientific Sessions; Nov. 13-15, 2021 (virtual meeting).