Abstract 17048: The Association of Neighborhood Deprivation With Racial Disparities in 30-day Heart Failure Readmissions in Middle Aged Adults

Abstract

Introduction: Neighborhood socioeconomic status (N-SES) is associated with incident heart failure (HF) and HF readmissions. N-SES may have a greater impact on young and middle-aged adults with heart failure (HF) due to fewer resources. Hypothesis: N-SES modifies the disparity in 30-d HF readmissions between Blacks and Whites in the Southeastern US. Methods: We created a geo-coded retrospective cohort of patients aged <65 years (N=11,469, mean age 52.1 yrs, 48% female, 46.5% Black) with at least one HF hospitalization at any Emory Healthcare facility from 2010-2018. Quartiles of the Social Deprivation Index (SDI), derived from US Census data, characterized neighborhood deprivation at the census tract level. Linear probability models estimated the “excess 30-d HF readmissions” between Blacks and Whites (referent) within each quartile of neighborhood deprivation. A base model accounted for geographical clustering, age, gender, and insurance type; a fully adjusted multivariable model further adjusted for clinical variables (composite Charlson Comorbidity Index, HbA1c, BP, SaO2, and HR). Results: Compared with Whites, Blacks were more likely to reside in deprived census tracts, be female, have public insurance, and higher comorbidity scores (Table 1). Between 2010-2018, 20.5% of Black and 12.5% of White patients experienced a 30-d HF readmission (p<.001). Black excess in HF readmissions ranged from 6.7% (95%CI: 3.6%-9.7%) to 8.4% (95%CI: 4.9%-12.0%) within the 2 nd and 4 th deprivation quartiles, respectively (Figure 1), with no excess readmissions in the least deprived quartile. Accounting for comorbidities and clinical presentation eliminated the Black excess in 30-d HF readmissions in the 2 nd quartile but not within higher levels of area deprivation. Conclusions: Excess 30-d HF readmissions in middle aged Blacks increases with neighborhood deprivation and was not explained by patient sociodemographics or comorbidities in the most deprived Census tracts.