Abstract 14135: Neighborhood Socioeconomic Status and Heart Failure or All-Cause Readmission Within a Safety-Net System

Abstract

Introduction: Neighborhood socioeconomic status (NSES) independently predicts higher rates of heart failure (HF) readmission, but whether this is true in a safety-net system is uncertain. Methods: We conducted a retrospective EHR-based cohort study of adults with HF between 2001-2019 at a municipal safety-net hospital in SF using Fine-Gray survival models. Most recent residential addresses were geocoded. NSES index is a composite measure including income, education, employment, and housing scaled to the SF Bay Area as quintiles (1=lowest, 5=highest). Results: Among 2,507 individuals with index HF hospitalization, 179 (7.1%) were readmitted within 30 days for HF and 374 (14.9%) for any cause. Within 1 year, 639 (25.5%) were readmitted for HF and 1,185 (47.3%) for any cause. In unadjusted analyses, NSES is associated with HF readmission at 30 days (p=0.013) or 1 year (p=0.021) and all-cause readmission at 30 days (p=0.0015) or 1 year (p=0.0049). Adjusted for demographics, substance use, and comorbidities, Quintile 1 has 58% higher risk of HF readmission (HR=1.58, 95% CI 1.07-2.33, p=0.021) and 56% higher risk of all-cause readmission (HR=1.56, 95% CI 1.19-2.05, p=0.001) over 1 year than Quintile 5. Similarly, compared to Quintile 5, all quintiles have higher risk of all-cause readmission over 1 year from Quintile 2 (HR=1.53, 95% CI 1.16-2.03, p=0.003) to Quintile 4 (HR=1.50, 95% CI 1.10-2.03, p=0.010). Including GDMT prescription does not change these results. Conclusion: NSES is associated with a higher risk of HF and all-cause readmissions over 1 year in a safety-net hospital. Further studies should investigate NSES domains to identify interventions and address disparities.