Racial and ethnic disparities in longitudinal trajectories of hospitalizations in patients diagnosed with heart failure

Abstract

Background

Racial and ethnic disparities in hospitalizations among heart failure (HF) patients have been well documented. However, little is known about racial and ethnic differences in the long-term trajectories of hospital admissions that follow the diagnosis of HF.

Methods

We used electronic health records (EHR) of 5,606 patients with newly-diagnosed HF between January 1, 2015 and July 28, 2018 in the Duke University Health System. Patients were followed for up to 5 years (until July 28, 2023) to identify all-cause hospital admissions after their initial diagnosis of HF. Group-based trajectory models were used to identify major trajectories of hospitalization, and multinomial logistic regression models were used to identify patients’ clinical and nonclinical characteristics associated with the trajectories of admissions.

Results

In our study cohort (mean age 74.8 ± 5.8 years), we identified 4 distinct trajectories of hospitalization during follow up: 45.6% (Group 1: N = 2,556) had “low risks” of hospitalization, 36.6% (Group 2: N = 2,052) had elevated risks of admission shortly after diagnosis (“early risk” group), 9.9% (Group 3: N = 553) had elevated risks at later stages of illness (“late risk” group), and 7.9% (Group 4: N = 445) had consistently “high risks” of hospitalization. Non-Hispanic Black patients were more likely to exhibit early risks of hospitalization (odds ratio [OR], 1.33; 95% confidence interval [CI], 1.16-1.52; P < .001), late risks of hospitalization (OR = 1.92; 95% CI, 1.58-2.34; P < .001), or consistently high risks of hospitalization (OR = 1.89; 95% CI, 1.52-2.35; P < .001) compared with non-Hispanic White patients. Diabetes, chronic kidney disease, and residence in a disadvantaged neighborhood significantly contributed to the excess risks of admissions among non-Hispanic Black patients. We found no significant differences in patterns of admissions between patients from other racial and ethnic groups compared with non-Hispanic White patients.

Conclusions

Non-Hispanic Black patients had early, late, and consistently high risks of hospitalization following the diagnosis of HF compared with non-Hispanic White patients. These findings have important implications for targeting interventions to reduce hospitalizations during the course of HF management.