心力衰竭
医学
人口学
弱势群体
种族(生物学)
健康的社会决定因素
社会经济地位
老年学
内科学
公共卫生
环境卫生
政治学
人口
社会学
护理部
法学
性别研究
作者
Matthew W. Segar,Neil Keshvani,Shreya Rao,Gregg C. Fonarow,Sandeep R Das,Ambarish Pandey
出处
期刊:Circulation-heart Failure
[Ovid Technologies (Wolters Kluwer)]
日期:2022-11-01
卷期号:15 (11)
标识
DOI:10.1161/circheartfailure.121.009401
摘要
Background: Racial disparities in heart failure hospitalization and mortality are well established; however, the association between different social determinants of health (SDOH) and length of stay (LOS) and the extent to which this association may differ across racial groups is not well established. Methods: We utilized data from the Get With The Guidelines-Heart Failure registry to evaluate the association between SDOH, as determined by patients’ residential ZIP Code and LOS among patients hospitalized with heart failure. We also assessed the race-specific contribution of the ZIP Code–level SDOH to LOS in patients of Black and non-Black races. Finally, we evaluated SDOH predictors of racial differences in LOS at the hospital level. Results: Among 301 500 patients (20.2% Black race), the median LOS was 4 days. In adjusted analysis accounting for patient-level and hospital-level factors, SDOH parameters of education, income, housing instability, and foreign-born were significantly associated with LOS after adjusting for clinical status and hospital-level factors. SDOH parameters accounted for 25.8% of the total attributable risk for prolonged LOS among Black patients compared with 10.1% in patients of non-Black race. Finally, hospitals with disproportionately longer LOS for Black versus non-Black patients were more likely to care for disadvantaged patients living in ZIP Codes with a higher percentage of foreign-born and non-English speaking areas. Conclusions: ZIP Code–level SDOH markers can identify patients at risk for prolonged LOS, and the effects of SDOH parameters are significantly greater among Black adults with heart failure as compared with non-Black adults.
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