A National Study of U.S. Emergency Departments: Racial Disparities in Hospitalizations for Heart Failure.

Autor: Lo AX; Department of Emergency Medicine and Center for Healthcare Studies, Northwestern University, Chicago, Illinois. Electronic address: alexander.lo@northwestern.edu., Donnelly JP; Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama., Durant RW; Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama., Collins SP; Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee., Levitan EB; Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama., Storrow AB; Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee., Bittner V; Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
Jazyk: angličtina
Zdroj: American journal of preventive medicine [Am J Prev Med] 2018 Nov; Vol. 55 (5 Suppl 1), pp. S31-S39.
DOI: 10.1016/j.amepre.2018.05.020
Abstrakt: Introduction: Racial disparities in heart failure hospitalizations are well documented. The majority of heart failure hospitalizations originate from emergency departments, but emergency department hospitalization patterns for heart failure and the factors that influence hospitalization are poorly understood. This gap in knowledge was examined using a nationally representative sample of emergency department visits for heart failure.
Methods: National Hospital Ambulatory Medicare Care Survey data on 2001-2010 emergency department visits were analyzed in 2015-2017 to examine age-related racial differences in hospitalization patterns for heart failure, using multivariable modified Poisson regression models.
Results: More than 12million adult visits for heart failure to U.S. emergency departments occurred from 2001 to 2010, with 23% of visits by blacks. Overall, 71% of visits resulted in hospitalization (57% to floor beds and 14% to intensive care units). Among floor admissions for higher clinical acuity visits, whites were more likely than blacks to be hospitalized. Whites with higher clinical acuity were more likely to be hospitalized than those with lower clinical acuity (71% vs 63%, p=0.005). This expected pattern was not observed in blacks, particularly those aged ≥65years, who were hospitalized in 71% of lower clinical acuity visits, but only 61% of higher acuity visits. Among adults aged ≥65years, there was a significant interaction between clinical acuity Xrace with regard to hospitalization (p=0.037).
Conclusions: These results suggest age and racial disparities in hospitalization rates for emergency department patients with heart failure. The reasons for these disparities in hospitalization are unclear. Further studies on emergency department hospitalization decisions, and the impact of emergency department clinical factors, may help clarify this finding.
Supplement Information: This article is part of a supplement entitled African American Men's Health: Research, Practice, and Policy Implications, which is sponsored by the National Institutes of Health.
(Copyright © 2018 Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: