Association Between Socioeconomic Disadvantage and Risks of Early and Recurrent Admissions Among Patients With Newly Diagnosed Heart Failure.

BACKGROUND: Socioeconomic disadvantage is associated with greater risks of hospital readmission and mortality among patients with heart failure (HF). However, it is less clear whether socioeconomic disadvantage has an immediate and lasting impact on the risk of admissions after the diagnosis of HF. METHODS: We used electronic health record data of patients aged 65 years and older with newly diagnosed HF between January 2015 and July 2018 in the Duke University Health System, with up to 8 years of follow-up. We assessed the association between neighborhood-level disadvantage, measured by the area deprivation index (lower, moderate, or higher) and hospital admissions within 30, 90, and 180 days after HF diagnosis using multivariable logistic regression models. We also assessed the risk of recurrent admissions over follow-up using Prentice, Williams, and Peterson models with total time. RESULTS: In our cohort of 5889 patients (mean [SD] age, 75 (6) years; 51% women; 67% non-Hispanic White), 71% of patients had at least one admission, and ≈50% of patients died over a median follow-up of 5.6 years. Unadjusted models showed that patients residing in higher disadvantaged neighborhoods had incrementally increasing risks for admissions within 30 days (odds ratio [OR], 1.17 [95% CI, 0.99-1.38]), 90 days (OR, 1.18 [95% CI, 1.03-1.35]), and 180 days (OR, 1.23 [95% CI, 1.08-1.40]) after diagnosis compared with patients in lower disadvantaged areas. These risks were no longer significant after adjusting for patients' clinical and nonclinical characteristics at 30 days (OR, 1.09 [95% CI, 0.90-1.31]), 90 days (OR, 1.07 [95% CI, 0.92-1.25]), and 180 days (OR, 1.10 [95% CI, 0.96-1.27]). However, patients living in higher disadvantaged areas had significantly greater risks of recurrent admissions over follow-up (hazard ratio, 1.11 [95% CI, 1.05-1.16]; P<0.001) compared with patients in lower disadvantaged areas. CONCLUSIONS: Our findings suggest that patients with HF residing in areas of socioeconomic disadvantage are at higher risk for recurrent admissions and thus should be considered for targeted intervention strategies.

Duke Scholars

Author Scott Michael Lynch Sociology

Author Hanzhang Xu School of Nursing

Author Bradley Gordon Hammill Population Health Sciences

Author Jessica Sayles West Communication Sciences

Author Michael Green  

Author Lesley H. Curtis Population Health Sciences

Author Matthew E. Dupre Population Health Sciences