Racial or ethnic differences in hospitalization for heart failure among elderly adults: Medicare, 1990 to 2000

Abstract

Little is known about racial or ethnic differences in hospitalizations for heart failure (HF), the most common hospital diagnosis for Medicare enrollees. Using data from the Medicare Provider Analysis Record (1990-2000), we analyzed data for Medicare beneficiaries aged > or = 65 years who were hospitalized with a first-listed diagnosis of HF (International Classification of Diseases, Ninth Revision, Clinical Modification code 428). We assessed racial/ethnic differences in annual prevalences and discharge outcomes for patients hospitalized in 2000. Prevalence of HF hospitalization increased over the 10-year period for white, black, Hispanic, and Asian enrollees. Prevalence was highest among those aged > or = 85 years; the age-adjusted prevalence was greater among men than women. Compared with white enrollees in 2000, the likelihood of a HF hospitalization was 1.5 times greater among black enrollees, 1.2 times greater among Hispanic enrollees, and 0.5 times less likely among Asian enrollees after adjustment for age and sex (P < .05 for all). Compared with white patients hospitalized with HF, black and Hispanic (but not Asian) patients were less likely than white patients to die in a hospital. A greater proportion of black, Hispanic, and Asian patients were discharged to home than white patients during 2000. Prevalence of HF hospitalization was highest among black and Hispanic Medicare enrollees. Because Hispanic Americans and the elderly are the fastest-growing segments of the US population, HF will increase in importance as a public health concern and will require increased focus on culturally competent prevention and treatment strategies in the next decade.