Keele Research Repository

Averbuch, T, Mohamed, MO ORCID: https://orcid.org/0000-0002-9678-5222, Islam, S, DeFilippis, EM, Breathett, K, Alkhouli, MA, Michos, ED, Martin, GP, Kontopantelis, E, Mamas, MA ORCID: https://orcid.org/0000-0001-9241-8890 and Van Spall, HGC (2021) The association between socioeconomic status, sex, race/ethnicity and in-hospital mortality among patients hospitalized for heart failure. Journal of Cardiac Failure.

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Abstract

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.

Item Type:	Article
Additional Information:	The final version of this article and all relevant information related to it, including copyrights, can be found online via the publisher website at; https://www.onlinejcf.com/article/S1071-9164(21)00394-8/fulltext#%20
Subjects:	R Medicine > R Medicine (General) R Medicine > RC Internal medicine R Medicine > RC Internal medicine > RC666 Diseases of the circulatory (Cardiovascular) system
Divisions:	Faculty of Medicine and Health Sciences > School of Medicine
Related URLs:	Author
Depositing User:	Symplectic
Date Deposited:	09 Nov 2021 15:03
Last Modified:	09 Nov 2021 15:03
URI:	https://eprints.keele.ac.uk/id/eprint/10247

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