Background/Purpose: Heart failure (HF) is a leading cause of hospital admissions. In the US, Blacks have higher HF prevalence than other racial/ethnic groups. Cardiovascular disease (CVD) risks are elevated in SLE, but racial/ethnic variation in HF prevalence in SLE has not been well studied. We examined rates and adjusted risks of HF admissions among SLE patients overall and by race/ethnicity within Medicaid, the US health insurance program for the poor.

Methods: Within Medicaid Analytic eXtract (MAX), containing billing claims from 2000-10 for Medicaid patients from the 29 most populated US states, we identified patients aged 18-65 with prevalent SLE (≥3 ICD-9 codes 710.0, ≥30 days apart) with ≥6 months of continuous enrollment prior to the 3^rd diagnosis code (index date). Baseline data from the 6 months prior to index date included age, sex, race/ethnicity, zip code, year, SLE-related and other comorbidities (based on ICD-9 codes). Those missing race/ethnicity were excluded. Within MAX inpatient claims, ICD-9 codes identified multiple types of HF as primary or secondary discharge diagnoses (Chen J, Circulation, 2013). Subjects were followed from index date to first HF admission, death, Medicaid disenrollment, or end of follow-up. HF admission rates per 1000 person-years with 95% CIs were calculated overall and within subgroups. Fine and Gray proportional hazards regression models, accounting for the competing risk of death, were used to calculate subdistribution hazard ratios (HR) for HF hospitalization, adjusting for sociodemographics and comorbidities.

Results: Of 57,292 patients with prevalent SLE, 93.2% were female. Racial/ethnic breakdown was: 41% Black, 39% White, 15% Hispanic, 3% Asian, 1% Native American. Mean follow-up was 3.67 (±3.03) years, 2,596 (5%) patients had ≥1 HF hospitalization, and 3,972 (7%) patients died. The HF admission rate was 12.76 (95%CI 12.28, 13.26) per 1,000 person-years for the entire cohort. Asians and Hispanics had the lowest HF admission rates: 7.49 (95%CI 5.76, 9.73) and 8.75 (95%CI 7.78, 9.84) per 1,000 person-years. Blacks had the highest rates: 17.56 (95%CI 16.68, 18.48) per 1,000 person-years. After adjustment, the HR for HF admission was 1.84 (95%CI 1.68, 2.02) among Blacks vs. Whites, and 1.82 (95%CI 1.66, 1.99) after further comorbidity adjustment (Table). Sensitivity analyses restricting to the primary discharge diagnosis (1,560 events) yielded similar results for Blacks vs. Whites: HR 2.06 (95% CI 1.83, 2.32), and 2.10 (95%CI 1.86, 2.40) after further comorbidity adjustment.

Conclusion: Rates of HF hospitalization were high in all racial/ethnic groups of SLE Medicaid patients. In multivariable models, Black SLE Medicaid patients had nearly two-fold higher risks of HF hospitalization than Whites and higher risks than all other groups. Future analyses will seek to differentiate prevalent vs. incident HF and examine different HF etiologies.

« Back to 2015 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/variation-in-heart-failure-hospitalizations-among-u-s-medicaid-recipients-with-sle-2000-2010-by-race-and-ethnicity/