Centers for Disease Control and Prevention, Division for Heart Disease and Stroke Prevention, 4770 Buford Hwy NE, Mailstop F-72, Atlanta, GA 30341, USA.
Prev Chronic Dis. 2012;9:E85. Epub 2012 Apr 12.
Preventable hospitalization for congestive heart failure (CHF) is believed to capture the failure of the outpatient health care system to properly manage and treat CHF. In anticipation of changes in the national health care system, we report baseline rates of these hospitalizations and describe trends by race over 15 years.
We used National Hospital Discharge Survey data from 1995 through 2009, which represent approximately 1% of hospitalizations in the United States each year. We calculated age-, sex-, and race-stratified rates and age- and sex-standardized rates for preventable CHF hospitalizations on the basis of the Agency for Healthcare Research and Quality's specifications, which use civilian population estimates from the US Census Bureau as the denominator for rates.
Approximately three-fourths of the hospitalizations occurred among people aged 65 years or older. In each subgroup and period, rates were significantly higher (P < .05) for blacks than whites. Only black men aged 18 to 44 showed a linear increase (P = .004) in crude rates across time. Subpopulations aged 65 or older, except black men, showed a linear decrease (P < .05) in crude rates over time. Age- and sex-standardized rates showed a significant linear decrease in rates for whites (P = .01) and a borderline decrease for blacks (P = .06)
Before implementation of the Patient Protection and Affordable Care Act, we found that blacks were disproportionately affected by preventable CHF hospitalizations compared with whites. Our results confirm recent findings that preventable CHF hospitalization rates are declining in whites more than blacks. Alarmingly, rates for younger black men are on the rise.
充血性心力衰竭（CHF）可预防性住院被认为是门诊医疗体系未能妥善管理和治疗 CHF 的表现。我们预计国家医疗体系将会发生变化，因此报告了这些住院的基线率，并在 15 年间按种族描述了其趋势。
我们使用了 1995 年至 2009 年的全国医院出院调查数据，这些数据代表了美国每年约 1%的住院人数。我们根据美国医疗保健研究与质量局的规范，计算了年龄、性别和种族分层的可预防性 CHF 住院率，以及基于美国人口普查局的平民人口估计作为率的分母的年龄和性别标准化率。
大约四分之三的住院发生在 65 岁或以上的人群中。在每个亚组和时期，黑人的比率都显著高于白人（P <.05）。只有年龄在 18 至 44 岁的黑人男性在整个时间内显示出粗率的线性增加（P =.004）。除了黑人男性外，年龄在 65 岁或以上的亚群在整个时间内显示出粗率的线性下降（P <.05）。年龄和性别标准化率显示白人的比率显著线性下降（P =.01），黑人的比率略有下降（P =.06）。
在《患者保护与平价医疗法案》实施之前，我们发现与白人相比，黑人受到可预防性 CHF 住院的影响不成比例。我们的结果证实了最近的发现，即白人的可预防性 CHF 住院率下降幅度大于黑人。令人震惊的是，年轻黑人男性的比率正在上升。
