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

Authors

Radha Dhingra
Hanzhang Xu
Bradley G Hammill
Scott M Lynch
Jessica S West
Michael D Green
Eric D Peterson
Lesley H Curtis
Matthew E Dupre

Language

English

Publication Date

12-1-2024

Journal

Circulation: Population Health and Outcomes

DOI

10.1161/CIRCOUTCOMES.124.011141

PMID

39584256

PMCID

PMC11652234

PubMedCentral® Posted Date

12-1-2025

PubMedCentral® Full Text Version

Author MSS

Abstract

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.

Keywords

Humans, Heart Failure, Female, Male, Aged, Time Factors, Risk Factors, Risk Assessment, Patient Readmission, Social Determinants of Health, Aged, 80 and over, Socioeconomic Factors, Health Status Disparities, Neighborhood Characteristics, North Carolina, Patient Admission, Retrospective Studies, Recurrence, Electronic Health Records, Vulnerable Populations, Prognosis, Socioeconomic Disparities in Health, heart failure, social determinants of health, neighborhood-level disadvantage, recurrent admissions, hospital readmissions

Published Open-Access

yes

Recommended Citation

Dhingra, Radha; Xu, Hanzhang; Hammill, Bradley G; et al., "Association Between Socioeconomic Disadvantage and Risks of Early and Recurrent Admissions Among Patients With Newly Diagnosed Heart Failure" (2024). Faculty, Staff and Student Publications. 5767.
https://digitalcommons.library.tmc.edu/uthgsbs_docs/5767