Social Deprivation Index Is Associated with 90-Day Emergency Department Revisits, but Not Admission, for Acute Heart...

Prevalence of heart failure is increasing, with an associated rise in emergency department (ED)-related care. Social determinants of health (SDoH) are associated with adverse health outcomes, but the extent to which they influence ED use for heart failure care is poorly understood. We sought to describe the relationship between community-level social vulnerability and ED revisits and hospital admissions for heart failure within a single health system.

We conducted a retrospective review of Social Deprivation Index (SDI) scores (higher score = more deprivation) by ZIP code paired with administrative clinical data. Zero-hurdle regression was used to model the relationship between SDI and ED revisits within 90 days of a prior ED visit for heart failure (logistic model for > 0 revisits; Poisson model for count of revisits). We used a mixed-effects logistic model-accounting for repeat visits-to test the association of SDI with hospital admission at any given ED visit.

From January 2022-December 2023, there were 3,569 ED visits from 2,406 patients. Each standard deviation increase in SDI (30.3) was associated with increased odds of at least one 90-day revisit (OR, 1.53; 95% CI, 1.08-2.16). Higher SDI was also associated with more 90-day revisits, with varying magnitude by hospital. After adjusting for characteristics of prior ED visit, SDI was not associated with hospital admission.

Our results suggest that area-level social vulnerability influences the decision to seek heart failure-related care in the ED. Patients from more deprived areas may not have more severe clinical presentations, however, as evidenced by lack of association of SDI with hospital admission.