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Congestive heart failure hospitalizations and survival in California: patterns according to race/ethnicity
M Alexander1, K Grumbach, L Remy
1Medical Effectiveness Research Center for Diverse Populations, University of California, San Francisco, CA, USA.
Insights
African Americans face higher congestive heart failure hospitalization and rehospitalization rates. However, they experience lower mortality compared to white populations, indicating complex disparities in care and outcomes.
Area of Science:
- Cardiology
- Public Health
- Health Disparities
Background:
- Congestive heart failure (CHF) disproportionately impacts African Americans.
- Limited data exist on CHF hospitalization patterns in growing Hispanic and Asian populations.
- Race/ethnic differences in CHF rehospitalization and survival are largely unknown.
Purpose of the Study:
- To assess CHF hospitalization, readmission, and survival rates across diverse racial and ethnic groups in California.
- To investigate disparities in congestive heart failure outcomes.
Main Methods:
- Population-based incidence of CHF hospitalization in California (1991).
- Retrospective cohort study of patients hospitalized for CHF (1991-1992) followed for 12 months.
- Cox proportional hazards models used for data analysis.
Main Results:
- African Americans had the highest CHF hospitalization rates.
- African Americans were more likely to be rehospitalized than whites and Asians.
- African Americans had lower 12-month mortality rates compared to whites, who had the highest mortality.
Conclusions:
- Significant racial-ethnic disparities exist in CHF morbidity and mortality.
- Higher hospitalization/rehospitalization and lower mortality in African Americans suggest potential differences in CHF pathophysiology or care access.
- Further research is needed to elucidate these paradoxical outcomes.
Background:
Congestive heart failure (CHF) disproportionately affects African Americans, but data are limited concerning CHF hospitalization patterns among Hispanic and Asian populations, the 2 fastest growing ethnic groups in the United States, and race/ethnic patterns of rehospitalization and survival among patients with CHF are unknown. We conducted a study to assess rates of CHF hospitalization, readmission, and survival among diverse populations in California.
Methods And Results:
We used 2 study designs. First, we calculated the population-based incidence of CHF hospitalization in California in 1991. Next we conducted a retrospective cohort study that identified patients initially hospitalized for CHF in 1991 or 1992 and followed these patients for 12 months after their index hospitalization to determine their likelihood of rehospitalization or death. Data were analyzed with Cox proportional hazards models. African Americans had the highest rate of CHF hospitalization. Age-adjusted hospitalization rates were comparable among whites, Latinos, and Asian women and all lower than those in African American, whereas Asian men had the lowest rates. On adjusted analyses, African Americans were more likely than whites and Asians to be rehospitalized (relative risk 1.07; 95% confidence interval 1.04 to 1.10). However, they were less likely to die within the 12-month follow-up period (relative risk 0.86; 95% confidence interval 0.82 to 0.90). Whites, conversely, had the highest posthospitalization mortality rates.
Conclusions:
These findings demonstrate important racial-ethnic differences in CHF morbidity and mortality rates. The disparate findings of higher hospitalization and rehospitalization rates and lower mortality rates among African Americans than whites may represent differences in the underlying pathophysiology of CHF in these groups or differences in access to quality care. Further studies are needed to explain these seemingly paradoxical outcomes.