Dhingra Radha, Xu Hanzhang, Hammill Bradley G, Lynch Scott M, West Jessica S, Green Michael D, Peterson Eric D, Curtis Lesley H, Dupre Matthew E
Department of Population Health Sciences (R.D., B.G.H., M.D.G., L.H.C., M.E.D.), Duke University, Durham, NC.
Duke University School of Nursing (H.X.), Duke University, Durham, NC.
Circ Cardiovasc Qual Outcomes. 2024 Dec;17(12):e011141. doi: 10.1161/CIRCOUTCOMES.124.011141. Epub 2024 Nov 25.
Socioeconomic disadvantage is associated with greater risks of hospital readmission and mortality among patients with heart failure (HF). However, it is less clear whether socioeconomic disadvantage has an immediate and lasting impact on the risk of admissions after the diagnosis of HF.
We used electronic health record data of patients aged 65 years and older with newly diagnosed HF between January 2015 and July 2018 in the Duke University Health System, with up to 8 years of follow-up. We assessed the association between neighborhood-level disadvantage, measured by the area deprivation index (lower, moderate, or higher) and hospital admissions within 30, 90, and 180 days after HF diagnosis using multivariable logistic regression models. We also assessed the risk of recurrent admissions over follow-up using Prentice, Williams, and Peterson models with total time.
In our cohort of 5889 patients (mean [SD] age, 75 (6) years; 51% women; 67% non-Hispanic White), 71% of patients had at least one admission, and ≈50% of patients died over a median follow-up of 5.6 years. Unadjusted models showed that patients residing in higher disadvantaged neighborhoods had incrementally increasing risks for admissions within 30 days (odds ratio [OR], 1.17 [95% CI, 0.99-1.38]), 90 days (OR, 1.18 [95% CI, 1.03-1.35]), and 180 days (OR, 1.23 [95% CI, 1.08-1.40]) after diagnosis compared with patients in lower disadvantaged areas. These risks were no longer significant after adjusting for patients' clinical and nonclinical characteristics at 30 days (OR, 1.09 [95% CI, 0.90-1.31]), 90 days (OR, 1.07 [95% CI, 0.92-1.25]), and 180 days (OR, 1.10 [95% CI, 0.96-1.27]). However, patients living in higher disadvantaged areas had significantly greater risks of recurrent admissions over follow-up (hazard ratio, 1.11 [95% CI, 1.05-1.16]; <0.001) compared with patients in lower disadvantaged areas.
Our findings suggest that patients with HF residing in areas of socioeconomic disadvantage are at higher risk for recurrent admissions and thus should be considered for targeted intervention strategies.
社会经济劣势与心力衰竭（HF）患者再次住院和死亡的风险增加有关。然而，社会经济劣势是否对HF诊断后的入院风险有直接和持久的影响尚不清楚。
我们使用了杜克大学医疗系统2015年1月至2018年7月期间新诊断为HF的65岁及以上患者的电子健康记录数据，随访时间长达8年。我们使用多变量逻辑回归模型评估了邻里层面的劣势（通过地区剥夺指数衡量，低、中或高）与HF诊断后30天、90天和180天内住院之间的关联。我们还使用Prentice、Williams和Peterson模型以及总时间评估了随访期间再次入院的风险。
在我们的5889名患者队列中（平均[标准差]年龄，75（6）岁；51%为女性；67%为非西班牙裔白人），71%的患者至少有一次入院，约50%的患者在中位随访5.6年期间死亡。未调整的模型显示，与生活在低劣势地区的患者相比，生活在高劣势社区的患者在诊断后30天内入院的风险逐渐增加（比值比[OR]，1.17[95%置信区间，0.99 - 1.38]）、90天内（OR，1.18[95%置信区间，1.03 - 1.35]）和180天内（OR，1.23[95%置信区间，1.08 - 1.40]）。在对患者30天（OR，1.09[95%置信区间，0.90 - 1.31]）、90天（OR，1.07[95%置信区间，0.92 - 1.25]）和180天（OR，1.10[95%置信区间，0.96 - 1.27]）的临床和非临床特征进行调整后，这些风险不再显著。然而，与低劣势地区的患者相比，高劣势地区的患者在随访期间再次入院的风险显著更高（风险比，1.11[95%置信区间，1.05 - 1.16]；P<0.001）。
我们的研究结果表明，生活在社会经济劣势地区的HF患者再次入院的风险更高，因此应考虑采取针对性的干预策略。
