More HF Readmissions Among Black People From Deprived Neighborhoods

Black patients have greater 30-day heart failure (HF) hospital readmission rates than white patients that cannot be explained by CV risk factors or hospital characteristics, and instead are tied to living in socioeconomically deprived neighborhoods, new data suggest.

“Although hospital systems should continue to strive to provide high-quality care to all patients regardless of race, ethnicity, socioeconomic status, or other factors, there are long standing systemic and social inequities that contribute to health disparities and are robust predictors of health outcomes, as we found in this analysis,” said Alanna Morris, MD (Emory University School of Medicine, Atlanta, GA), during a late-breaking trial presentation at the virtual Heart Failure Society of America (HFSA) Virtual Annual Scientific Meeting 2020.

In Morris’ study, the absolute risk of 30-day readmission for acute HF over 8-year follow-up was 13.5% in white patients and 20.6% in Black patients (P < 0.001). Even after adjustment for sociodemographic, clinical, and hospital factors, HF readmission remained significantly higher among Black patients (RR 1.45; 95% CI 1.37-1.54).

Keith C. Ferdinand, MD (Tulane Heart and Vascular Institute, New Orleans, LA), the designated discussant for the study, said the connection between increased HF incidents and living in deprived areas raises important clinical and public health concerns that must be addressed.

These findings could serve as an aid to policymakers going forward in terms of allocating resources for primary healthcare. Keith Ferdinand

“These findings could serve as an aid to policymakers going forward in terms of allocating resources for primary healthcare,” he said. “It's important [when] looking at these data and other[s] that we target heart failure patients who reside in deprived neighborhoods before, during, and posthospitalization.”

More Comorbidities, Less Care From Cardiologists

Prior work by Morris has shown that living in a food desert—where options may be restricted to primarily convenience stores and fast food—is a predictor of all-cause and heart-failure-specific readmission, with over 80% of patients in food deserts being Black. For the new study, Morris and colleagues looked at racial disparities in 30-day acute HF readmissions among more than 30,000 patients in and around Atlanta who were treated at Emory-run facilities. Neighborhood deprivation was derived from quartiles of the Social Deprivation Index (SDI), obtained from US Census data.

At baseline, the majority of Black and white individuals in both groups had heart failure with reduced ejection fraction, although the numbers were higher for Black patients (48.1% vs 45.5%; P < 0.0001). Compared with white patients, those who were Black had higher rates of most comorbidities and a higher Charlson Comorbidity Index. Importantly, Black people also were much less likely than white people to be discharged by a cardiologist (26.8% vs 51.9%; P < 0.0001).

In addition to the higher absolute risk of HF readmission in Black patients, the data also demonstrated an excess risk within each quartile of neighborhood deprivation.

“Our analysis also examines one healthcare system in the southeast region of the US,” Morris noted. “Thus, our findings may not be generalizable to other areas of the country.”

Ferdinand noted that the association between neighborhood deprivation and HF has also been demonstrated in non-Black populations. In a large Swedish study, white adults with diabetes had higher rates of HF if they lived in high- versus low-deprivation neighborhoods, he said.

While the new data are important, Ferdinand pointed out that individual measures of socioeconomic status, such as education level attained, median household income, and median home value, were not collected.

“In the future, we need to have that type of detail when we look at these data so that we can dissect what it is about living in those neighborhoods that increases readmission,” he said, adding that it will also important to examine cognitive function and mental health in concert with clinical data.