Abstract 17587: In California, Heart Failure Rates Decline Yet Racial Disparities Persist (2007-2009)

Abstract

INTRODUCTION: We examine variation in prevalence of heart failure (HF) in California over three years (2007-2009) and associated co-morbidities by race and age. HYPOTHESIS: We assessed the hypothesis that despite declining HF rates in California between 2007-2009, the relative rate of HF in minority racial groups would reveal health disparities when compared to whites.

METHODS: California hospital discharge data for years 2007-2009 on HF patients (61,118 patients aged 20+ with ICD-9 codes of 402, 404, 428; racial groups were 57% white, 13% black, 19% Hispanic and 8% Asian/Pacific Islander). Prevalence rates were age-adjusted for each racial group per 100,000 U.S. standard population (2000). RESULTS: Three trends emerged from the analyses: (1) HF rates have declined by 8.5% during three years (from 284 per 100K in 2007 to 260 in 2009). The rate decline, however, varied by racial groups in that it was largest among whites (8.8%) and least among the Asian/Pacific Islanders (6.7%); (2) During these three years, age-adjusted Black/White and Hispanic/White HF rate ratios were 2.5 and 1.11, respectively; Asian/Pacific Islanders had the lowest HF rate ratio (0.69) compared to whites. (3) When age was added to the model, blacks had 5 times higher HF rates under the age of 64 compared to whites, and Hispanic rates were slightly higher in each age category compared to whites. While hypertension and diabetes emerged as primary co-morbid conditions across all racial groups particularly in ages 20-44, for ages 45+, atrial fibrillation, sleep apnea, prior stroke and prior myocardial infarction emerged as contributory factors.

CONCLUSION: HF rates are higher among younger black and Hispanic patients compared to their white counterparts. Given that HF is a common final pathway for many chronic diseases, HF represents a marker of health inequity between racial categories. To meet the goals of Healthy People 2020 of achieving health equity, eliminating disparities, and improving health for all groups, it is important to understand current diseases trends as shown above. Additional research is needed to determine whether aggressive treatment of hypertension and diabetes among younger minority adults might reduce onset of HF in these vulnerable populations.