Center for Population Health, University of Connecticut Health Center, Farmington, CT, USA.
Division of Behavioral Sciences and Community Health, University of Connecticut Health Center, Farmington, CT, USA.
Public Health Rep. 2020 Jan;135(1):56-65. doi: 10.1177/0033354919884306. Epub 2019 Nov 20.
Preventable hospitalizations for heart failure result in a large proportion of hospitalizations. The primary objective of this study was to describe longitudinal trends in the association of race/ethnicity with preventable hospitalizations for heart failure in Connecticut and differences in disparities by age.
We analyzed data on hospitalizations in all civilian acute-care hospitals in Connecticut during a 7-year period, 2009 through 2015. We used raking methodology to weight the nonhospitalized population to create a reference population representative of the state's general population. Multivariate regression models examined racial/ethnic disparities among adults aged 35-64, controlling for age, sex, and type of health insurance. For adults aged ≥65, regression models controlled for age and sex.
After controlling for age and sex, the non-Hispanic black to non-Hispanic white odds ratio for preventable hospitalizations for heart failure ranged from 5.2-6.4 during the study period among adults aged 35-64. Among adults aged ≥65, non-Hispanic black adults had significantly higher odds (range, 1.2-1.8) of preventable hospitalizations than non-Hispanic white adults. Rates among Hispanic adults were significantly higher than rates among non-Hispanic adults after controlling for age and sex among adults aged ≥65 in 2014 and 2015.
This research provides information for clinical and population-based interventions targeting racial/ethnic gaps in heart failure hospitalizations. Demonstrating the persistent black-white disparity and age differences in racial/ethnic disparities, this study emphasizes the need for focused prevention among vulnerable populations. Raking methodology is an innovative approach to eliminating selection bias in hospital discharge data.
可预防的心力衰竭住院导致了大量的住院治疗。本研究的主要目的是描述在康涅狄格州，种族/民族与心力衰竭可预防住院之间的纵向趋势，并比较不同年龄段差异的差异。
我们分析了 2009 年至 2015 年期间康涅狄格州所有民用急性护理医院的住院数据。我们使用耙式方法对未住院人群进行加权，以创建一个代表该州一般人群的参考人群。多变量回归模型检查了 35-64 岁成年人中的种族/民族差异，控制了年龄、性别和健康保险类型。对于≥65 岁的成年人，回归模型控制了年龄和性别。
在控制年龄和性别后，非西班牙裔黑人与非西班牙裔白人之间可预防的心力衰竭住院率在研究期间的 35-64 岁成年人中为 5.2-6.4。在≥65 岁的成年人中，非西班牙裔黑人成年人的可预防住院率明显高于非西班牙裔白人成年人（范围为 1.2-1.8）。在 2014 年和 2015 年，控制≥65 岁成年人的年龄和性别后，西班牙裔成年人的比率明显高于非西班牙裔成年人。
这项研究为针对心力衰竭住院的种族/民族差距的临床和基于人群的干预措施提供了信息。本研究证明了黑人和白人之间持续存在的差异以及种族/民族差异的年龄差异，强调了在弱势群体中进行有针对性预防的必要性。耙式方法是消除出院数据选择偏差的创新方法。
