Hospitalization for congestive heart failure. Explaining racial differences.

OBJECTIVE To determine whether the higher rate of hospitalization among African Americans for congestive heart failure (CHF) could be explained by racial differences in the prevalence of clinical risk factors for CHF. DESIGN Retrospective cohort study. SETTING A large health maintenance organization (HMO). PATIENTS A sample of 64,877 enrollees (27% African American and 73% white) of the Northern California Kaiser Permanente Medical Care Program who took at least one multiphasic health checkup (MHC) at or after the age of 40 years and were free of CHF at that time. MAIN OUTCOME MEASURES First hospitalization with a principal diagnosis of CHF. RESULTS Among cohort members younger than 60 years at baseline MHC, the age-adjusted risk ratio (RR) (African American/white) for CHF hospitalization was 2.14 for men and 2.73 for women, while for persons 60 years of age and older at MHC, the age-adjusted RR was 1.48 for both sexes. Cox proportional hazards models were used to adjust for risk factors and length of follow-up. In persons aged 60 years and older, the race difference was explained by greater prevalence of hypertension and diabetes in African Americans (RR = 1.12; 95% confidence interval [CI], 0.94 to 1.34 after adjustment for hypertension and diabetes). In those younger than 60 years, findings differed by sex. For men, African-American race was no longer a significant predictor of CHF after adjusting for hypertension, diabetes, left ventricular hypertrophy on electrocardiogram, and body mass index (adjusted RR = 1.16; 95% CI, 0.86 to 1.56). However, among younger women, African Americans continued at increased risk despite adjustment for these variables as well as smoking, plasma cholesterol, renal function, alcohol use, and myocardial infarction (adjusted RR = 1.49; 95% CI, 1.00 to 2.21). CONCLUSIONS In this HMO population, the race differences in first hospitalization for CHF are largely explained by known clinical and behavioral risk factors, although in younger women these risk factors do not completely explain the excess risk among African Americans. These findings highlight the role of hypertension and diabetes in the development of CHF, particularly among African Americans.

[1]  E. Keeler,et al.  Health care for black and poor hospitalized Medicare patients. , 1994, JAMA.

[2]  E. Peterson,et al.  Racial variation in cardiac procedure use and survival following acute myocardial infarction in the Department of Veterans Affairs. , 1994, JAMA.

[3]  K. Bailey,et al.  The incidence and prevalence of congestive heart failure in Rochester, Minnesota. , 1993, Mayo Clinic proceedings.

[4]  J. Whittle,et al.  Racial differences in the use of invasive cardiovascular procedures in the Department of Veterans Affairs medical system. , 1993, The New England journal of medicine.

[5]  C. Gatsonis,et al.  Racial differences in the use of revascularization procedures after coronary angiography. , 1993, JAMA.

[6]  E. Cook,et al.  Effect of Race on the Presentation and Management of Patients with Acute Chest Pain , 1993, Annals of Internal Medicine.

[7]  T S Carey,et al.  Impact of socioeconomic status on hospital use in New York City. , 1993, Health affairs.

[8]  B. McNeil,et al.  Acute myocardial infarction in the Medicare population. Process of care and clinical outcomes. , 1992, JAMA.

[9]  K. Grumbach,et al.  America's safety net. The wrong place at the wrong time? , 1992, JAMA.

[10]  C Gatsonis,et al.  Rates of avoidable hospitalization by insurance status in Massachusetts and Maryland. , 1992, JAMA.

[11]  P E Leaverton,et al.  Prevalence and mortality rate of congestive heart failure in the United States. , 1992, Journal of the American College of Cardiology.

[12]  N. Krieger.  Overcoming the absence of socioeconomic data in medical records: validation and application of a census-based methodology. , 1992, American journal of public health.

[13]  Gillum Rf.  Cardiovascular disease in the United States: an epidemiologic overview. , 1991, Cardiovascular clinics.

[14]  R. Cooper,et al.  Trends in hospitalization rates for heart failure in the United States, 1973-1986. Evidence for increasing population prevalence. , 1990, Archives of internal medicine.

[15]  S. Yusuf,et al.  Changes in Hypertension Treatment and in Congestive Heart Failure Mortality in the United States , 1989, Hypertension.

[16]  R. Cooper,et al.  Precipitating factors leading to decompensation of heart failure. Traits among urban blacks. , 1988, Archives of internal medicine.

[17]  R. Gillum,et al.  Heart failure in the United States 1970-1985. , 1987, American heart journal.

[18]  L P Knudsen,et al.  Mortality among the elderly in the Alameda County Study: behavioral and demographic risk factors. , 1987, American journal of public health.

[19]  Graves Ej,et al.  1986 summary: National Hospital Discharge Survey. , 1984, Advance data.

[20]  R E Smith,et al.  The California Automated Mortality Linkage System (CAMLIS). , 1984, American journal of public health.

[21]  N. Weatherby,et al.  Causes of death which contribute to the mortality crossover effect. , 1978, Social biology.

[22]  S. Garfield.  Multiphasic health testing and medical care as a right. , 1970, The New England journal of medicine.

[23]  S R Garfield,et al.  The delivery of medical care. , 1970, Scientific American.

[24]  C. Hames,et al.  Prevalence of chronic congestive heart failure in the population of Evans County, Georgia. , 1966, American journal of epidemiology.