J Card Fail. 2021 Oct 7:S1071-9164(21)00394-8. doi: 10.1016/j.cardfail.2021.09.012. Online ahead of print.
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.