National Differences in Trends for Heart Failure Hospitalizations by Sex and Race/Ethnicity
Authors: Boback Ziaeian, Gerald F Kominski, Michael K Ong, Vickie M Mays, Robert H Brook, Gregg C Fonarow
Journal: Circulation (2017)

Original Article National Differences in Trends for Heart Failure Hospitalizations by Sex and Race/Ethnicity Boback Ziaeian, MD, PhD; Gerald F. Kominski, PhD; Michael K. Ong, MD, PhD; Vickie M. Mays, PhD; Robert H. Brook, MD, ScD; Gregg C. Fonarow, MD Downloaded from http://circoutcomes.ahajournals.org/ by guest on June 28, 2017 Background—National heart failure (HF) hospitalization rates have not been appropriately age standardized by sex or race/ ethnicity. Reporting hospital utilization trends by subgroup is important for monitoring population health and developing interventions to eliminate disparities. Methods and Results—The National Inpatient Sample (NIS) was used to estimate the crude and age-standardized rates of HF hospitalization between 2002 and 2013 by sex and race/ethnicity. Direct standardization was used to age-standardize rates to the 2000 US standard population. Relative differences between subgroups were reported. The national age- adjusted HF hospitalization rate decreased 30.8% from 526.86 to 364.66 per 100 000 between 2002 and 2013. Although hospitalizations decreased for all subgroups, the ratio of the age-standardized rate for men compared with women increased from 20% greater to 39% (P trend=0.002) between 2002 and 2013. Black men had a rate that was 229% (P trend=0.141) and black women, 240% (P trend=0.725) with reference to whites in 2013 with no significant change between 2002 and 2013. Hispanic men had a rate that was 32% greater in 2002 and the difference narrowed to 4% (P trend=0.047) greater in 2013 relative to whites. For Hispanic women, the rate was 55% greater in 2002 and narrowed to 8% greater (P trend=0.004) in 2013 relative to whites. Asian/Pacific Islander men had a 27% lower rate in 2002 that improved to 43% (P trend=0.040) lower in 2013 relative to whites. For Asian/Pacific Islander women, the hospitalization rate was 24% lower in 2002 and improved to 43% (P trend=0.021) lower in 2013 relative to whites. Conclusions—National HF hospitalization rates have decreased steadily during the recent decade. Disparities in HF burden and hospital utilization by sex and race/ethnicity persist. Significant population health interventions are needed to reduce the HF hospitalization burden among blacks. An evaluation of factors explaining the improvements in the HF hospitalization rates among Hispanics and Asian/Pacific Islanders is needed. (Circ Cardiovasc Qual Outcomes. 2017;10:e003552. DOI: 10.1161/CIRCOUTCOMES.116.003552.) Key Words: comorbidity ◼ healthcare disparities ◼ heart failure ◼ hospitalization ◼ population groups ◼ population surveillance ◼ public health H expected to increase from $20.9 billion in 2012 to $53.1 billion in 2030 with 80% of expenditures attributed to hospitalization. 4 Approximately 80% of the medical costs related to HF result from inpatient hospital care. 4 The Affordable Care Act pri- oritizes the containment of hospitalization costs, and whether preventable hospitalizations will be reduced secondary to the expanded insurance markets needs to be observed. 8 Limited data exist on the trends and differential HF hospitalization rates by sex and race/ethnicity, particularly when applying appropriate statistical age standardization. Demographically standardized hospitalization rates are a use- ful marker of differences in the HF hospitalization burden. Subgroups defined by race/ethnicity, sex, socioeconomic status, and region are disproportionally burdened by cardiovascular eart failure (HF) is the fourth leading cause of hospitaliza- tion and the leading cause of hospitalization for cardiovas- cular conditions in the United States. 1 Among adults aged >85 years, HF is the number one cause of hospitalization. 1 The total number of primary HF hospitalizations per year in the United States has been steady at ≈1 million for the past decade. 2,3 In 2012, an ≈5.7 million American adults had HF based on self- report. 2 By 2030, the prevalence of HF is expected to increase 46% to >8 million people secondary to an aging demographic nationally. 4 However, national prevalence estimates based on self-report are likely lower than the true HF prevalence because 31% to 57% of patients underreport a HF diagnosis. 5,6 The prevalence of HF is also not equally distributed by sex and race/ethnicity. 7 Projected total costs for HF medical care are Received January 6, 2017; accepted May 15, 2017. From the Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA (B.Z., G.F.K., V.M.M., R.H.B.); Division of Cardiology (B.Z.) and Department of Internal Medicine (M.K.O.), Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA; Division of General Internal Medicine and Health Services Research (M.K.O., R.H.B.) and Division of Cardiology (B.Z., G.C.F.), David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Psychology, University of California, Los Angeles (V.M.M.); and Ahmanson-UCLA Cardiomyopathy Center, UCLA Medical Center, Los Angeles, CA (G.C.F.). The Data Supplement is available at http://circoutcomes.ahajournals.org/lookup/suppl/doi:10.1161/CIRCOUTCOMES.116.003552/-/DC1. Correspondence to Gregg C. Fonarow, MD, Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan UCLA Medical Center, 10833 LeConte Ave, Room A2-237 CHS, Los Angeles, CA 90095–1679. E-mail gfonarow@mednet.ucla.edu © 2017 American Heart Association, Inc. Circ Cardiovasc Qual Outcomes is available at http://circoutcomes.ahajournals.org DOI: 10.1161/CIRCOUTCOMES.116.003552