title: Acculturation and outcomes among patients with heart failure.
abstract: BACKGROUND
  Acculturation to US society among minority patients may-beyond race and ethnicity alone-influence health outcomes beyond race and ethnicity alone. In particular, those who are foreign-born and who do not speak English as their primary language may have greater challenges interacting with the health care system and thus be at greater risk for adverse outcomes.
  
  
  RESULTS
  We studied patients hospitalized with a principal discharge diagnosis of heart failure between January 2000 and December 2007 in an integrated delivery system that cares for minority patients. Individuals were defined as having low acculturation if their primary language was not English and their country of birth was outside of the United States. Multivariable logistic regression and Cox proportional hazards regression were used to determine the independent risk of 30-day rehospitalization and 1-year mortality, respectively. Candidate adjustment variables included demographics (age, sex, race/ethnicity), coexisting illnesses, laboratory values, left ventricular systolic function, and characteristics of the index admission. Of 1268 patients, 30% (n=379) were black, 39% (n=498) were Hispanic, and 27% (n=348) were white. Eighteen percent (n=228) had low acculturation. After adjustment, low acculturation was associated with a higher risk of readmission at 30 days (odds ratio, 1.70; 95% confidence interval, 1.07-2.68) but not 1-year all-cause mortality (hazard ratio, 0.69; 95% confidence interval, 0.42-1.14).
  
  
  CONCLUSIONS
  Patients with heart failure who are foreign-born and do not speak English as their primary language have a greater risk of rehospitalization, independent of clinical factors and race/ethnicity. Future studies should evaluate whether culturally concordant interventions focusing on such patients may improve outcomes for this patient population.
authors.affiliation: Denver Health Medical Center, Denver, CO, USA. Pamela.Peterson@ucdenver.edu
authors.forename: Pamela N
authors.initials: PN
authors.lastname: Peterson
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Campagna
authors.forename: Moises
authors.initials: M
authors.lastname: Maravi
authors.forename: Larry A
authors.initials: LA
authors.lastname: Allen
authors.forename: Sheana
authors.initials: S
authors.lastname: Bull
authors.forename: John F
authors.initials: JF
authors.lastname: Steiner
authors.forename: Edward P
authors.initials: EP
authors.lastname: Havranek
authors.forename: L Miriam
authors.initials: LM
authors.lastname: Dickinson
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Masoudi
mesh_terms: D000069:Acculturation; D002423:Cause of Death / Q000639:trends; D003120:Colorado / Q000453:epidemiology; D016001:Confidence Intervals; D005006:Ethnicity / Q000208:ethnology*; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000208:ethnology* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D008913:Minority Groups; D016017:Odds Ratio; D010359:Patient Readmission / Q000639:trends*; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors