title: Racial and Ethnic Differences in Heart Failure Readmissions and Mortality in a Large Municipal Healthcare System.
abstract: This study sought to determine whether racial and ethnic differences exist among patients with similar access to care. We examined outcomes after heart failure hospitalization within a large municipal health system.
  
  
  
  Racial and ethnic disparities in heart failure outcomes are present in administrative data, and one explanation is differential access to care.
  
  
  
  We performed a retrospective cohort study of 8,532 hospitalizations of adults with heart failure at 11 hospitals in New York City from 2007 to 2010. Primary exposure was ethnicity and race, and outcomes were 30- and 90-day readmission and 30-day and 1-year mortality rates. Generalized estimating equations were used to test for associations between ethnicity and race and outcomes with covariate adjustment.
  
  
  
  Of the number of hospitalizations included, 4,305 (51%) were for blacks, 2,449 (29%) were for Hispanics, 1,494 (18%) were for whites, and 284 (3%) were for Asians. Compared to whites, blacks and Asians had lower 1-year mortality, with adjusted odds ratios (aORs) of 0.75 (95% confidence interval [CI]: 0.59 to 0.94) and 0.57 (95% CI: 0.38 to 0.85), respectively, and rates for Hispanics were not significantly different (aOR: 0.81; 95% CI: 0.64 to 1.03). Hispanics had higher odds of readmission than whites (aOR: 1.27; 95% CI: 1.03 to 1.57) at 30 (aOR: 1.40; 95% CI: 1.15 to 1.70) and 90 days. Blacks had higher odds of readmission than whites at 90 days (aOR:1.21; 95% CI: 1.01 to 1.47).
  
  
  
  Racial and ethnic differences in outcomes after heart failure hospitalization were present within a large municipal health system. Access to a municipal health system may not be sufficient to eliminate disparities in heart failure outcomes.
authors.affiliation: Department of Medicine, New York University School of Medicine, New York, New York.
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Durstenfeld
authors.affiliation: Department of Medicine, New York University School of Medicine, New York, New York; Department of Population Health, New York University School of Medicine, New York, New York; Global Institute of Public Health, New York University, New York, New York.
authors.forename: Olugbenga
authors.initials: O
authors.lastname: Ogedegbe
authors.affiliation: Department of Medicine, New York University School of Medicine, New York, New York.
authors.forename: Stuart D
authors.initials: SD
authors.lastname: Katz
authors.affiliation: Department of Population Health, New York University School of Medicine, New York, New York.
authors.forename: Hannah
authors.initials: H
authors.lastname: Park
authors.affiliation: Department of Medicine, New York University School of Medicine, New York, New York; Department of Population Health, New York University School of Medicine, New York, New York. Electronic address: saul.blecker@nyumc.org.
authors.forename: Saul
authors.initials: S
authors.lastname: Blecker
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D001213:Asian / Q000706:statistics & numerical data; D015331:Cohort Studies; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D054625:Healthcare Disparities; D006333:Heart Failure; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009519:New York City; D016017:Odds Ratio; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult
keywords: ethnicity; health disparities; heart failure; morbidity; mortality; outcomes research