Abstract
Background/Aims Racial disparities of 30-day readmission rates have been found in Medicare beneficiaries with congestive heart failure (CHF); however, racial disparities in the younger age groups remained unknown. Further, the association between patient demographics, site of care and 30-day readmissions are understudied. Our study aims to identify racial disparities in CHF patients across age groups, site of care and 30-day readmission rate, and to explore potential contributing variables to the racial disparity in CHF.
Methods This study used the 2009 Florida State Healthcare Cost and Utilization Project State Inpatient Databases (HCUP-SID). Patients 18 years or older, hospitalized with a primary diagnosis of CHF were included in this study. Multi-level modeling examined if racial disparities in risk-adjusted 30-day readmission rate could be explained by patients’ characteristics (age, gender, insurance, household income, rurality, length of stay, discharge status) and hospital characteristics (whether the site of care was a minority-serving hospital at their initial admission, defined as the top 10% of hospitals who served the highest proportion of non-white patients).
Results Racial disparities existed in CHF patients’ age at discharge, site of care, and risk-adjusted 30-day readmission rate. African American CHF patients as a group were hospitalized on average 14 years younger than Whites, and 10 years younger than Hispanics (AA: 63 vs. White: 77 vs. Hispanics: 73, P <0.001). Overall, Hispanic patients had the highest readmission rate (Hispanics: 27.7%, AA: 25.9%, White: 24%). Higher readmission rates were associated with race of minority, Medicare and Medicaid program enrollment, lower income, discharge status, minority-serving hospital, and younger age (age<55: 29%, age 55–64: 27%, age 65–74: 25%, age 75–84: 24%, age>84: 22%. P <0.001). This age trend remained in Medicare and Medicaid beneficiaries, but not in the private insurance or uninsured patient population. Minority-serving hospitals had a significantly higher 30-day readmission rate (minority-serving: 29.2% vs. non-minority-serving: 24.3%, P <0.001).
Conclusions Minority patients were admitted for CHF at much younger ages and experienced a higher 30-day readmission rate. Minority-serving hospitals served more vulnerable patients and had a significantly higher 30-day readmission rate. There is a need to provide multifaceted approaches to reduce disparities in CHF, particularly for minority and vulnerable populations.
