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The association between socioeconomic status, sex, race/ethnicity and in-hospital mortality among patients hospitalized for heart failure

Mamas

The association between socioeconomic status, sex, race/ethnicity and in-hospital mortality among patients hospitalized for heart failure Thumbnail


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Abstract

Background The association between socioeconomic status (SES), sex, race/ethnicity and outcomes during hospitalization for heart failure (HF) has not previously been investigated. Methods We analyzed HF hospitalizations in the United States National Inpatient Sample between 2015-2017. Using a hierarchical, multivariable Poisson regression model to adjust for hospital- and patient-level factors, we assessed the association between SES, sex, and race/ethnicity and all-cause in-hospital mortality. We estimated the direct costs (USD) across SES groups. Results Among 4,287,478 HF hospitalizations, 40.8% were in high SES, 48.7% in female, and 70.0% in White patients. Relative to these comparators, low SES (homelessness or lowest quartile of median neighborhood income) (Relative risk [RR] 1.02, 95% CI 1.00-1.05) and male sex (RR 1.09, 95% CI 1.07-1.11) were associated with increased risk, whilst Black (RR 0.79, 95% CI 0.76-0.81) and Hispanic (RR 0.90, 95% CI 0.86-0.93) race/ethnicity were associated with reduced risk of in-hospital death. There were significant interactions between race/ethnicity and both, SES (p<0.01) and sex (p=0.04) such that racial/ethnic differences in outcome were more pronounced in low SES groups and in male patients. The median direct cost of admission was lower in low vs high SES groups ($9324.60 vs $10940.40), female patients vs male patients ($9866.60 vs $10217.10), and Black vs White patients ($9077.20 vs $10019.80). The median costs increased with SES in all demographic groups. Conclusions SES, race/ethnicity, and sex were independently associated with in-hospital mortality during HF hospitalization, highlighting possible care disparities. Racial/ethnic differences in outcome were more pronounced in low SES groups and in male patients.

Acceptance Date Sep 20, 2021
Publication Date Oct 7, 2021
Journal Journal of Cardiac Failure
Print ISSN 1071-9164
Publisher Elsevier
DOI https://doi.org/10.1016/j.cardfail.2021.09.012
Publisher URL https://www.onlinejcf.com/article/S1071-9164(21)00394-8/fulltext#