Association Between Socioeconomic Disadvantage and Risks of Early and Recurrent Admissions Among Patients With Newly Diagnosed Heart Failure.
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2024-12
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Abstract
Background
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.Methods
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.Results
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]; P<0.001) compared with patients in lower disadvantaged areas.Conclusions
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.Type
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Dhingra, Radha, Hanzhang Xu, Bradley G Hammill, Scott M Lynch, Jessica S West, Michael D Green, Eric D Peterson, Lesley H Curtis, et al. (2024). Association Between Socioeconomic Disadvantage and Risks of Early and Recurrent Admissions Among Patients With Newly Diagnosed Heart Failure. Circulation. Cardiovascular quality and outcomes, 17(12). p. e011141. 10.1161/circoutcomes.124.011141 Retrieved from https://hdl.handle.net/10161/34279.
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Scholars@Duke
Hanzhang Xu
Dr. Hanzhang Xu, PhD, RN, FAAN, is an Associate Professor at the Duke University School of Nursing with joint appointments at the Duke University School of Medicine in the Department of Family Medicine and Community Health and the Duke-NUS Medical School in the Health Services & Systems Research Signature Program. She also serves as a Senior Fellow at Duke's Center for the Study of Aging and Human Development and as a Faculty Affiliate at the Duke Global Health Institute.
As a clinician scientist, Dr. Xu’s research and scholarship center around social determinants of health and disparities in health care and outcomes in diverse older adult populations, with a particular focus on cardiovascular and brain health. Her current program of research falls under two themes: (i) health disparities in a multinational context, with a particular focus on the cognitive function and dementia care among older adults; and (ii) the integration of patient-reported social factors in cardiovascular outcome research.
She has led several research projects funded by the National Institutes of Health (NIH) that leverage the strengths of big data repositories such as electronic health records (EHR), Medicare claims, national survey data and disease registries to improve the cardiovascular and brain health of older adults, with a total award amount being over $5 million. Her work in these areas has been widely cited by researchers in at least 53 countries across 6 continents, and has been featured in international media outlets, including in Yahoo!, TIME, Forbes, and the Mirror.
Dr. Xu is a Fellow of the American Academy of Nursing and was inducted into Sigma Theta Tau International Honor Society of Nursing. She serves on the Editorial Board of the Journal of Aging and Health.
Xu earned her PhD from Duke University.
Bradley Gordon Hammill
Brad Hammill, DrPH, is an Associate Professor in the Department of Population Health Sciences within the School of Medicine and a member of the Duke Clinical Research Institute. Dr. Hammill received his DrPH in Biostatistics from The University of North Carolina at Chapel Hill. His research is focused on leveraging real-world data—including electronic health record data, health insurance claims data, and registry data—for clinical research.
Areas of expertise: Biostatistics, Real-World Data, Health Services Research, Health Policy, and Epidemiology
Scott Michael Lynch
Jessica Sayles West
Jessica is a medical sociologist whose research examines hearing loss stigma, aging, and health disparities across the life course. Her work integrates sociological theory, population health sciences, and hearing healthcare to understand how hearing loss and hearing-related stigma shape mental health, social relationships, healthcare experiences, and quality of life among diverse populations. Jessica has documented the broader consequences of hearing loss for individuals and families, identified sociodemographic disparities in hearing health, and helped advance the measurement of hearing loss stigma. Supported by a National Institute on Deafness and Other Communication Disorders (NIDCD) K01 Career Development Award, her current research program focuses on documenting, measuring, and reducing stigma associated with hearing loss to improve health outcomes and advance hearing health equity. Her research has been published in leading journals including, the Journals of Gerontology, Social Science & Medicine, Ear and Hearing, and other prominent outlets in medical sociology, population health, audiology, and aging research.
Jessica received a B.A. from the University of Michigan in Social Anthropology (dual Sociology/Anthropology concentration) followed by an M.P.H. in Sociomedical Sciences with a certificate in Public Health Research Methods from Columbia University’s Mailman School of Public Health. She subsequently received an M.A. and Ph.D. in Sociology with a focus in Medical Sociology and Demography at Duke University. She then completed an NIA T32 Postdoctoral Fellowship at the Duke University Aging Center. She is currently an Assistant Professor in Head and Neck Surgery & Communication Sciences at the Duke University School of Medicine, a Faculty Research Scholar in the Duke University Population Research Institute, and a Senior Fellow in the Duke University Aging Center.
Lesley H. Curtis
Lesley H. Curtis, PhD, is the James B. Duke Distinguished Professor and Chair of the Department of Population Health Sciences in the Duke School of Medicine. Dr. Curtis also holds a faculty appointment in Medicine. A health services researcher by training, Dr. Curtis is an expert in the use of health care and Medicare claims data for health services and clinical outcomes research, and a leader in national data quality efforts. Dr. Curtis has led the linkage of Medicare claims with several large clinical registries and epidemiological cohort studies including the Framingham Heart Study and the Cardiovascular Health Study. Dr. Curtis served as a senior policy advisor at the Food and Drug Administration supporting the Agency’s evidence generation initiative, serves as an Investigator in the Coordinating Center for PCORI's PCORnet, and is co-PI of the NIH Pragmatic Trials Collaboratory, an NIH initiative to strengthen the national capacity for large-scale research studies embedded in health care delivery.
Areas of expertise: Health Services Research and Health Policy
Matthew E. Dupre
Dr. Dupre is a Professor in the Department of Population Health Sciences and the Department of Sociology. He is also a Senior Fellow at the Center for Aging and Human Development and faculty scholar at DUPRI's Center for Population Health & Aging. Dr. Dupre is a medical sociologist who specializes in research on aging and the life course, health disparities, and cardiovascular disease (CVD) outcomes in older adults. As an interdisciplinary researcher, he has focused on several lines of work: (i) race and socioeconomic disparities in trajectories of chronic disease and mortality, (ii) the role of social stressors in the onset and progression of CVD, (iii) the development of adaptive risk-assessment models, and (iv) the social determinants of healthy aging in China. A unifying thread in his program of research is the application of life course theory to clinical outcomes research, the integration of population- and patient-level data, and the use of innovative statistical methods to better understand how exposure to social factors shape inequalities in health and aging. Dr. Dupre is the Editor-in-Chief of the Encyclopedia of Gerontology and Population Aging (2021), co-editor of the book Disability Trends at Older Ages (in press), and has published in the leading journals of medicine, epidemiology, sociology, and public health. He has served as an advisor to the National Academy of Sciences' Committee on Population Aging and currently serves on the editorial boards for multiple journals.
Areas of Expertise:
Medical Sociology; Population Health; Social Epidemiology; Cardiovascular Disease; Aging; and Quantitative Methods
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