Lack of Evidence for Racial Disparity in 30-Day All-Cause Readmission Rate for Older US Veterans Hospitalized with Heart Failure

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Abstract

Background:

Heart failure is the leading cause for 30-day all-cause readmission. Although racial disparities in health care are well documented, their impact on 30-day all-cause readmission rate is inconclusive.

Objective:

We examined the impact of racial disparity on 30-day readmission for hospitalized patients with heart failure.

Methods:

This is a retrospective secondary data analysis for a large veteran cohort in 130 Veterans Affairs Medical Centers. Propensity scores were used to reduce differences in age, gender, survival days, and comorbidities in index hospitalization among 46 524 whites and 14 124 African Americans (AA).

Results:

At index hospitalization, AA patients were younger (73.04 vs 67.10 years, t = −54.58, P < .000) and less likely to have myocardial infarcts (8.02% vs 9.80%, t = −6.36, P = .000), peripheral vascular disease (15.25% vs 22.51%, t = −18.68, P = .000), chronic obstructive pulmonary disease (39.59% vs 50.05%, t = −21.89, P < .000), and complicated diabetes (23.42% vs 26.24%, t = −6.73, P = .000). AA patients had lower mortality 30 days post–index hospitalization (3.51% vs 5.69%, t = −10.23, P = .000). In contrast, AA patients were more likely to have renal disease (44.03% vs 38.71%, t = 11.32, P < .000) and HIV/AIDS (1.56% vs 0.20%, t = 19.71, P < .000). The 30-day all-cause readmission rate before adjustments was 17.82% for AA patients versus 18.72% for white patients. There was no difference in the 2 rates after adjustments (18% vs 18%; odds of readmission = 1.002, z = 0.08, P = .937).

Conclusions:

In a large Department of Veterans Affairs (VA) cohort, white and AA veterans hospitalized for heart failure had similar 30-day all-cause readmission rates after adjustments were made for age, gender, survival days, and comorbidities. However, the 30-day all-cause mortality rate was higher for white patients than for AA patients. Future prospective studies are needed to validate results and test generalizability outside the VA system of care.

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