Abstract 10682: Health Disparity in Patients With Heart Failure: Ethnicity and Financial Status
BACKGROUND: Morbidity and death are higher in Blacks and in low financial status patients with heart failure (HF) compared with Whites and those with high financial status. Differences in self-care behaviors may play a role in this disparity in outcomes.
Objective: To explore the relationships among ethnicity, financial status and cardiac event-free survival, and reasons for disparity in outcomes.
METHODS: We enrolled 231 patients with HF (male 65%, White 84%, age 61±12, NYHA III/IV 57%). Patient demographics (e.g., ethnicity, financial status, age, gender, social support), clinical data (e.g., medication and medical history), and self-care behaviors were collected at baseline. Self-care behaviors were assessed by Self-Care of Heart Failure Index. Patients were followed up to 3.5 years for events. Patients were grouped by ethnicity and financial status: high if they reported having “enough or more than enough to make ends meet” and low if they “did not have enough to make ends meet”. Survival analyses were used to explore the relationships among ethnicity, financial status and survival. Chi-square and ANOVA were used to explore reasons for disparity in outcomes.
RESULTS: Cardiac event-free survival was better in Whites with high financial status than in patients in any of the other three groups (ie., Blacks with low and high financial status and Whites with low financial status). Patients in these 3 groups had 3 times the risk of an event compared to Whites with high financial status (P < .05, Figure). Whites with high financial status were younger, had higher perceived social support, and engaged in more self-care behaviors than the other 3 groups.
CONCLUSION: In Blacks, ethnicity rather than financial status was related to worse outcomes. In Whites, low financial status rather than ethnicity was related to worse outcomes. Interventions focused on social support and improving self-care may decrease the disparity in outcomes related to both ethnicity and financial status.
- © 2013 by American Heart Association, Inc.