Abstract
Introduction: Valvular heart diseases (VHD) are a growing public health problem but effect of race on temporal changes in VHD hospitalizations, valve surgeries and hospital mortality rates is undefined. Hypothesis: Non-White patients (pts) with VHD are at higher risk of hospital mortality vs White pts. Methods: We retrospectively analyzed all inpatient hospital records obtained between 1983-2012 from the New York State Statewide Planning and Research Cooperative System database with a primary or secondary ICD-9 code for VHD and racial self-classification (n=2,443,056). Linear regression was used to evaluate temporal changes in numbers of valve hospitalizations and valve surgeries performed among racial groups; ANOVA, χ 2 and t-tests were used, as appropriate, to compare subgroup differences on baseline clinical characteristics and lengths of stay; logistic regression (age, gender-adjusted) compared risk of hospital mortality by race. Results: During the 30-yr interval, proportions of non-White (predominantly Black) to White VHD pts increased by 65.9% (all VHD) and 72.1% (valve surgery). Though 12±1 yrs younger than White pts (p<.001), Black pts had more concomitant hypertension, diabetes, heart failure and/or kidney disease and longer lengths of stay (p<.001, all) vs White pts. Across all racial groups, hospital death risk was highest among Black pts (Figure), with men at greatest risk among all VHD cases (OR= 1.27, 95% CI=1.22-1.31, p<.001) and women at highest risk after valve surgery (OR= 1.32, 95% CI=1.18-1.48, p<.001). Conclusions: Pt demographics in New York hospitals are changing: pts from minority racial groups are proportionally increasing. The higher hospital mortality rates among Black pts with VHD is unexplained, though racial disparities in access to care and health risk factors may be involved. These disparities require evaluation as they will increasingly impact the health care system as the numbers of affected individuals continue to grow.
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