Excess 30-Day Heart Failure Readmissions and Mortality in Black Patients Increases With Neighborhood Deprivation.
Excess 30-Day Heart Failure Readmissions and Mortality in Black Patients Increases With Neighborhood Deprivation.
复制标题
DOI：
10.1161/circheartfailure.120.007947
复制
发表时间：
2020-12
期刊：
影响因子：
--
通讯作者：
Morris AA
中科院分区：
文献类型：
--
作者：
Patel SA;Krasnow M;Long K;Shirey T;Dickert N;Morris AA
在美国，心力衰竭(HF)结局中长期存在的种族差异存在，部分原因是健康的社会决定因素。我们研究了邻里环境是否改变了美国东南部黑人和白人患者之间30天心力衰竭再入院和死亡率的差异。我们创建了2010-2018年间Emory Healthcare内因急性心力衰竭(AHF)住院的患者的地理编码回顾队列。社会剥夺指数(SDI)的四分位数表征了人口普查区域一级的社区贫困。我们估计了AHF住院指数后30天再入院和30天死亡率的相对风险。根据地理分布、人口学、临床和医院特征进行调整后，再入院率和死亡率被估计为每个SDI四分位数内黑人和白人患者之间的绝对风险差异。队列包括30,630名患者，平均年龄66岁，其中48%为女性，53%为黑人。与白人患者相比，黑人患者更有可能居住在贫困的人口普查地区，并有更高的共病得分。从2010年到2018年，29.4%的黑人和23.0%的白人患者经历了30天的心衰再入院或30天的死亡(p<；0.001)。黑人患者30天心力衰竭再入院和死亡率的超标率从3.9%(95%可信区间：1.5%−6.3%；P=0.0002)到6.8%(95%可信区间：4.1%−9.5%；P<；0.0001)。考虑到传统的危险因素，并没有消除任何邻近四分位数的合并30天心力衰竭再入院和/或死亡率中的布莱克过剩。超过30天的心力衰竭再入院和死亡率在每个社区阶层的黑人患者中都存在，并随着社区社会经济贫困的进展而增加。
Longstanding racial disparities in heart failure (HF) outcomes exist in the United States, in part due to social determinants of health. We examined whether neighborhood environment modifies the disparity in 30-d HF readmissions and mortality between Black and White patients in the Southeastern US. We created a geo-coded retrospective cohort of patients hospitalized for acute HF (AHF) within Emory Healthcare from 2010–2018. Quartiles of the Social Deprivation Index (SDI) characterized neighborhood deprivation at the census tract level. We estimated the relative risk of 30-d readmission and 30-d mortality following an index hospitalization for AHF. “Excess” readmissions and mortality were estimated as the absolute risk difference between Black and White patients within each SDI quartile, adjusted for geographical clustering, demographic, clinical, and hospital characteristics. The cohort included 30,630 patients, mean age 66 years, 48% female, 53% Black. Compared with White patients, Black patients were more likely to reside in deprived census tracts, and have higher comorbidity scores. From 2010 to 2018, 29.4% of Black and 23.0% of White patients experienced either a 30-d HF readmission or 30-d death (p<0.001). Excess in composite 30-d HF readmissions and mortality for Black patients ranged from 3.9% (95%CI: 1.5%−6.3%; P=0.0002) to 6.8% (95%CI: 4.1% −9.5%; P<0.0001) across SDI quartiles. Accounting for traditional risk factors did not eliminate the Black excess in combined 30-d HF readmissions and/or mortality in any of the neighborhood quartiles. Excess 30-d HF readmissions and mortality are present among Black patients in every neighborhood strata, and increase with progressive neighborhood socioeconomic deprivation.