Abstract 22: Association of Hospital Race and Payer Mix With Inpatient Mortality Among Patients Admitted for Acute Coronary Syndrome, Heart Failure and Arrhythmia

Abstract

Background: Patient characteristics insufficiently explain observed disparities in cardiovascular outcomes among hospitalized patients, suggesting a role for community or hospital-level factors. Here, we evaluate the association of hospital segregation by black race and payer mix with inpatient mortality using a nationally representative sample of hospitalizations. Methods: Using the National Inpatient Sample (NIS), we identified adult hospitalizations with a primary diagnosis of acute coronary syndrome (n=550,005), heart failure (n=863,870) and atrial/ventricular arrhythmia (n=656,070). We divided NIS hospitals in to quartiles based on percent of hospital black and low payer (Medicaid or uninsured) admissions. We utilized logistic regression to determine whether hospital race or low payer quartile was associated with inpatient mortality among those admitted for acute coronary syndrome (ACS), heart failure (HF) and atrial/ventricular arrhythmia. Models were adjusted for age, sex, patient comorbidities, and hospital characteristics. Results: The mean age (95% CI) of the ACS, HF, and arrhythmia cohorts was 66.8 (66.7-67.0), 71.7 (71.5-71.9) and 70.0 (69.8-70.1) years, respectively. In adjusted models, ACS patients admitted to hospitals with >18.7-25.7% (Q2), >25.7%-34.0% (Q3), and >34.0% (Q4) low payer admissions experienced a 12% (OR 1.12, 1.03-1.20), 10% (OR 1.10, 1.01-1.19), and 12% (OR 1.12, 1.02-1.23) increased odds of inpatient mortality, respectively, when compared to hospitals with ≤18.7% low payer admissions (Q1). In the arrhythmia cohort, patients admitted to hospitals with >34.0% (Q4) low payer admissions experienced a 25% increased odds of inpatient mortality compared to those admitted to hospitals with ≤18.7% (Q1) low payer admissions (OR 1.25, 1.11-1.41). Among heart failure patients, those admitted to hospitals with >20.5% (Q4) black patients experienced a 17% (OR 0.83, 0.74-0.93) decreased odds of inpatient mortality compared to those admitted to hospitals with ≤4% (Q1) black admissions. Conclusion: Hospital low payer makeup positively associates with odds of inpatient mortality among patients admitted for acute coronary syndrome and arrhythmia. Hospital black makeup inversely associates with odds of inpatient mortality among patients admitted for heart failure.