Abstract
The management of heart failure is characterized by high rates of hospital admission
as well as rehospitalization after inpatient treatment of this disorder, whereas skillful
medical care may reduce the risk of hospital admission. The purpose of this study
was to examine the relation between income (as a measure of socioeconomic status)
and the frequency of hospital readmission among a large and diverse group of persons
treated for heart failure. We analyzed administrative discharge data from 236 nonfederal
acute-care hospitals in New York State, involving 41,776 African-American or Caucasian
hospital survivors with International Classification of Diseases, Ninth Revision,
Clinical Modification codes for heart failure in the principal diagnosis position
between January 1 and December 31, 1995. Household income was derived from postal
ZIP codes and census data. We found that patients residing in lower income neighborhoods
were more often women or African-Americans, had more comorbid illness, had higher
use of Medicaid insurance, and were more often admitted to rural hospitals. There
was a stepwise decrease in the crude frequency of readmission from the lowest quartile
of income (23.2%) to the highest (20.0%) (p <0.0001 for Mantel-Haenszel chi-square
test for trend across all quartiles; p <0.0001 for comparison between quartiles 1
and 4). After adjustment for baseline differences and process of care, income remained
a significant predictor, with an increase in the risk of readmission noted in association
with lower levels of income (adjusted odds ratio for quartile 1:4 comparison, 1.18;
95% confidence interval, 1.10 to 1.26, p <0.0001). We conclude that lower income patients
hospitalized for treatment of heart failure in New York differ from higher income
patients in important clinical and demographic comparisons. Even after adjustment
for these fundamental differences and other potential confounding factors, lower income
is a positive predictor of readmission risk.
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Article info
Publication history
Accepted:
January 16,
2001
Received in revised form:
January 16,
2001
Received:
October 19,
2000
Identification
Copyright
© 2001 Excerpta Medica Inc. Published by Elsevier Inc. All rights reserved.
