HEALTHCARE DISPARITIES IN HEART FAILURE BETWEEN CAUCASIAN AND ASIAN POPULATIONS IN THE UNITED STATES

Abstract

SESSION TITLE: Monday Electronic Posters 2 SESSION TYPE: Original Inv Poster Discussion PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM PURPOSE: Healthcare disparities are a growing public health concern. Literature has shown that 30.6% of direct medical expenditures for African-Americans, Asian-Americans, and Hispanics were excess-costs due to health inequalities. Heart failure (HF) admissions are frequently cited as a prime example of how health inequalities can lead to increased hospitalizations and readmissions. Since HF is a frequent admission diagnosis and there is concern for healthcare disparities, we investigated whether there are cost differences between Caucasians (standard population) and Asians for HF admissions. METHODS: We conducted a retrospective analysis by use of the Healthcare Cost and Utilization Project - Nationwide Inpatient Sample (HCUP-NIS) database. Patients with HF were selected from hospital admissions between 2009 and 2004. The clinical classifications software (CCS) code of 108 was used to query all HF hospitalizations, including those with reduced and preserved ejection fraction. Using the statistical software SAS, weighted descriptive analyses were completed to produce national estimates of US hospitalizations. Variables of age, hospitalization charges, in-hospital mortality, length of stay, number of procedures during hospitalization, income quartile by zip code and Elixhauser comorbidity index scores were evaluated. SAS was also used for ANOVA with Tukey analysis. RESULTS: Between 2009 and 2014, there were a total of 5,491,051 HF admissions in the United States. Of this, 3,458,333 patients were Caucasian and 91,700 were Asians. The mean age of hospital admission was 75.76 for Caucasians and 71.4 for Asians (p< 0.05). The total charge billed at the time of discharge was $38,034 for Caucasians and $59,668 for Asians (p<0.05). Inpatient mortality for Caucasians was 3.54% versus 3.01% for Asians (p<0.05). The mean length of stay for Caucasians was 5.16 days versus 5.33 days for Asians (p<0.05). The average number of procedures was 1.02 for Caucasians and 1.36 for Asians (p<0.05). In terms of income, the average quartile by zip code was 2.41 for Caucasians and 2.87 for Asians (p<0.05). Lastly, the average Elixhauser comorbidity score was 5.96 and 6.94 (p<0.05) respectively for Caucasians and Asians. CONCLUSIONS: Overall, there was a 57% increase in cost of HF admissions for Asians than Caucasians. Interestingly, the age of presentation was earlier for Asians and they experienced less mortality. The increased charges may be reflective of a longer length of stay and increased number of procedures. Given the increased Elixhauser mortality score, it is possible that Asians are receiving more advanced therapies and medications not used for typical HF admissions, causing higher costs. CLINICAL IMPLICATIONS: Further research should be done to identify the underlying causes of these cost differences to decrease this healthcare disparity. Additionally, contributing risk factors for HF admissions should be further studied. DISCLOSURES: No relevant relationships by Kathir Balakumaran, source=Web Response No relevant relationships by Andre Gabriel, source=Web Response No relevant relationships by Varun Tandon, source=Web Response No relevant relationships by Aysha Tandon, source=Web Response