THE ASSOCIATION BETWEEN SEX, RACE, SOCIOECONOMIC STATUS, AND IN-HOSPITAL ALL-CAUSE MORTALITY AMONG PATIENTS ADMITTED FOR HEART FAILURE: A RETROSPECTIVE COHORT STUDY

Averbuch, Tauben; Mohamed, Mohamed; Islam, Shofiqul; Martin, Glen; Thabane, Lehana; Mamas, Mamas; Van Spall, Harriette G.C.

Abstract

Background
Heart failure (HF) hospitalization is associated with high mortality. We aimed to assess the role of race, sex, and socioeconomic status (SES) in the risk of in-hospital mortality among patients hospitalized for HF.

Methods
We used the National Inpatient Sample to analyze all hospitalizations for HF in the United States from 2015-2017. We extracted patient demographics and clinical characteristics. Using a multivariate Poisson regression model with interaction terms, we determined the relationship between sex, race, SES, and risk of in-hospital mortality.

Results
We identified 857,496 HF admissions, representing 4,287,478 HF admissions after applying discharge weights. Median (IQR) age of patients was 73.4 (62.4-82.9) years, 48.7% were women, 30.0% were non-White, and 33.1% were of low SES. There were 218,580 (5.1%) deaths. In the multivariate regression model, men (RR 1.09; 95% CI 1.07, 1.11) and those of low SES (RR 1.02; 95% CI 1.00, 1.04) experienced increased risk of in-hospital mortality relative to women and those of high SES, respectively, while Black (RR 0.78; 95% CI 0.75, 0.80) and Hispanic patients (RR 0.89; 95% CI 0.86, 0.93) experienced a reduced risk of in-hospital mortality relative to White patients. There was a significant interaction between race and sex (p=0.04), and race and SES (p <0.01), but not sex and SES (p=0.95). Hispanic race was associated with reduced risk of in-hospital mortality relative to White race among low (RR 0.88; 95% CI 0.82, 0.93) but not high SES (RR 0.93; 95% CI 0.87, 1.00) patients. Black race was associated with reduced risk of in-hospital mortality relative to white race among all SES groups, although the reduction was more pronounced among low (RR 0.74; 0.70, 0.77) than high SES patients (RR 0.80; 95% CI 0.75, 0.84). Similarly, risk of in-hospital mortality was lower in Black men (RR 0.74; 95% CI 0.71, 0.78) than Black women (RR 0.79, 95% CI 0.76, 0.83) relative to White men and women, respectively.

Conclusion
This retrospective cohort study confirms prior published associations between race and in-hospital mortality in HF and demonstrates the interaction between race, sex, and SES. These findings are novel and warrant further study.

Citation

Averbuch, T., Mohamed, M., Islam, S., Martin, G., Thabane, L., Mamas, M., & Van Spall, H. G. THE ASSOCIATION BETWEEN SEX, RACE, SOCIOECONOMIC STATUS, AND IN-HOSPITAL ALL-CAUSE MORTALITY AMONG PATIENTS ADMITTED FOR HEART FAILURE: A RETROSPECTIVE COHORT STUDY. Presented at ACC.21; 15-17 May 2021, Virtual

• Presentation Conference Type: Conference Paper (published)
• Conference Name: ACC.21; 15-17 May 2021
• Acceptance Date: May 3, 2021
• Online Publication Date: May 3, 2021
• Publication Date: 2021-05
• Deposit Date: Jun 28, 2023
• Journal: Journal of the American College of Cardiology
• Print ISSN: 0735-1097
• Electronic ISSN: 1558-3597
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 77
• Issue: 18
• Pages: 794
• DOI: https://doi.org/10.1016/s0735-1097%2821%2902153-7
• Keywords: Cardiology and Cardiovascular Medicine
• Public URL: https://keele-repository.worktribe.com/output/509626