Background: Hispanic and black patients with heart failure have been shown to have higher risk of readmission but lower risk of post-discharge mortality than white patients. To determine whether disparities exist among patients with similar access to care, we examined outcomes after heart failure hospitalization within a large municipal healthcare system.
Methods: This retrospective cohort study included adults hospitalized with a principal diagnosis of heart failure at the 11 hospitals in The New York City Health and Hospitals Corporation in 2007-2010. Clinical data from electronic health records were linked to New York State hospital registry and vital statistics data. The primary exposure was hospital-reported ethnicity/race, which was categorized as Hispanic, non-Hispanic black, and non-Hispanic white; patients of other and unknown races were excluded. Outcomes were 30 and 90-day readmission and 30-day and one-year mortality. Logistic regression models were used to test for association between ethnicity/race and outcomes with adjustment for demographics, comorbidities, lab results, and vital signs.
Results: Among 9,059 hospitalizations for heart failure (mean age 67±15 years), 2,629 (29%) were for Hispanic patients, 4,785 (53%) were for black patients, and 1,645 (18%) were for white patients. Of these patients, 3,248 (36%) had Medicare, 2,512 (28%) had Medicaid, and 1,489 (16%) had no insurance.
The one-year mortality rate was 24% (625 of 2,629) for Hispanics, 20% (964 of 4,785) for blacks, and 33% (541 of 1,645) for whites. Even after risk-adjustment, Hispanics and blacks had lower one-year mortality than whites, with adjusted odds ratios (aORs) of 0.78 (95% CI 0.67-0.91) and 0.78 (95% CI 0.68-0.90). Hispanics, but not blacks, had lower 30-day mortality compared to whites with aORs of 0.68 (95% CI 0.48-0.97) and 0.76 (95% CI 0.55-1.06).
Hispanics had higher rates of 30-day readmission than whites (aOR 1.25; 95% CI 1.09-1.44), but there was no difference between blacks and whites, (aOR 0.99; 95% CI 0.87-1.13). At 90 days, both Hispanics and blacks were more likely to be readmitted than whites with aORs of 1.39 (95% CI 1.22-1.59) and 1.13 (95% CI 1.00-1.29), respectively.
Conclusions: Racial and ethnic disparities in outcomes after heart failure hospitalization comparable to prior reports were present within a large municipal healthcare system. Although outcomes were similar for black and white patients for 30 days post-discharge, during longer-term follow-up, black patients had higher readmission rates and lower mortality rates than white patients. Hispanic patients had higher readmission rates and lower mortality rates compared to white patients during all intervals studied. Further research is needed to identify causes for these disparities.