Primary Submission Category: Race/Ethnicity
Socioeconomic Status is a Mediator for Hospital Readmissions Among African Americans with Congestive Heart Failure in the Philadelphia Area
Authors: Jonathan Arend Stephanie Kjelstrom Georgia Montone Gill Kim
Presenting Author: Jonathan Arend*
African Americans (AA) have the highest rate of cardiovascular related deaths in the US, and a higher risk of congestive heart failure (CHF) compared to non-Hispanic White (NHW) patients. Lower socioeconomic status (SES) is an independent risk factor for cardiovascular disease and those with CHF are more prone to hospital readmissions. No study to date has evaluated the mediation between race, socioeconomic status, and its association with hospital readmissions.
We extracted Electronic Health Record inpatient data of primary care patients from four community hospitals in our Philadelphia area heath care system from 2018 to 2022. We identified 1,614 patients with an index admission diagnosis of CHF and calculated the number of readmissions per person for the study period. SES was categorized into high (1-5) and low (6-10) SES using the area deprivation index. We used t-test and chi-square to compare NHW and AA patients and multivariable negative binomial regression models were built. Mediation was determined by first adding race to the model, then SES as the outcome and race as the predictor to a second logistic model. Finally, both were added to the first model.
AA patients were on average younger (70 vs 81 years), of low SES (79% vs 11%), had a higher mean readmission rate (2.9 vs 2.3), and higher percentages of comorbidities compared to NHW patients. In the first mediation model, AA patients had a higher risk of readmissions compared to White patients (IRR 1.1 [1.04, 1.3]). In the second model, low SES is significantly related to being AA (OR 23.0 [16.7, 31.6]). With both in the model, neither is significant, indicating that SES is a mediator for readmissions.
These findings support the need for distinct population health strategies for higher risk groups to manage chronic diseases including CHF. Surveillance, early detection and enhanced care management strategies may reduce readmission for a significant proportion of at-risk patients.