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The Association Between Social Determinants of Health, Race, and Sex on Risk for Readmission After Heart
Carolina Lemos1, Fabian Vargas1, Elena M Donald1
1Department of Medicine, Division of Cardiology New York Presbyterian Hospital / Columbia University Irving Medical Center, New York, New York.
Background:
Women, racial and ethnic minority groups, and patients of low socioeconomic status (SES) face barriers linked to adverse outcomes after heart transplantation (HT). Data are lacking regarding the association of these demographics with causes and frequency of readmissions.
Methods And Results:
We reviewed adult HT recipients at our institution from January 2005 to December 2022. Baseline characteristics, educational attainment, insurance payer, and primary language were collected. An SES index was calculated from patient-level zip codes. Reason(s) for and rates of readmissions within the first year post-HT were collected and compared by race, sex, and SES tertiles. Multivariable Cox models were used to determine predictors of hospitalization. Of 1139 HT recipients, 26% were women; 24% were non-Hispanic Black, and 16% were Hispanic; 43% had public insurance; and 9.7% were non-English speaking. The median SES score was 54.5 (interquartile range, 51.4-57.7), indicating moderately high SES. Nearly one-third had a high school level education or lower. Six percent (n = 72) died during their index hospitalization and 50% (n = 571) were readmitted within the first year. The leading causes of hospitalization were infection (39%) and rejection (20%). After adjusting for clinical and demographic characteristics, sex, race, and SES tertile did not predict the risk of hospitalization in the first year post-HT. However, recipients with lower educational attainment were significantly more likely to require re-admission (hazard ratio 1.41, 95% confidence interval 1.07-1.87, P = .016).
Conclusions:
Although SES, sex, and race were not predictors of readmission, lower educational attainment was associated with an increased cumulative incidence of rehospitalization within the first year. In light of the complex medical care required after HT, interventions such as tailored education that support all levels of health literacy are necessary to improve outcomes.
