Race and Income Association with Health Service Utilization for Veterans with Heart Failure

Abstract

Disproportionate heart failure outcomes exist for Blacks in the Veterans Health Administration (VHA) despite equitable access and financial barrier minmization. No study has examined the association of race and income with health service utilization for veterans with heart failure. This observational study investigated race and income associations with readmissions, bed days of care, and emergency room (ER) visits for veterans with heart failure after controlling for predisposing, enabling, and illness severity factors. Medical record data were collected for 149 veterans telemonitored for heart failure during 2008-2011. Heart failure symptoms severity and comorbidities were measured using investigator-adapted scales based on the New York Heart Association IIV scale and the Charlson comorbidity index. Heart failure related outcomes (30 day, 90 day, 1 year, and total readmissions, ER visits, and total bed days of care) were modeled controlling for age, marital status, and heart failure and comorbidity severity. Of patients younger than 60 years of age, 18% were Black compared to 11% of Whites, Χ2 (2, N=149) = 5.15, p= .02. Blacks had a much higher comorbidity prevalence than Whites, p = .000. Ischemic heart disease and chronic kidney disease rates were double and triple national VHA rates, respectively, among Whites and Blacks. Race did not predict readmissions, bed days of care, or ER visits. The odds of a readmission or bed day of care ever decreased by 38% and 43%, respectively, for married men, p = .03. The odds of a readmission or bed day of care ever due to severe heart failure—compared to less severe heart failure—were four to five times higher, respectively, p ≤ .004. Income increased the odds of total bed days of care by 14%, p = .00, holding race constant. Overall, the sample experienced far fewer readmissions, bed days of care, or ER visits, compared to VHA national rates, but sample size may have limited accurate comparisons.