Association of Hospital Racial Composition and Payer Mix With Mortality in Acute Coronary Syndrome

• Published in: Journal of the American Heart Association Vol. 8; no. 21; p. e012831
• Main Authors: Srivastava, Pratyaksh K, Fonarow, Gregg C, Bahiru, Ehete, Ziaeian, Boback
• Format: Journal Article
• Language: English
• Published: England John Wiley and Sons Inc 05-11-2019; Wiley
• Subjects: acute coronary syndrome; Acute Coronary Syndrome - mortality; Acute Coronary Syndrome - therapy; Aged; Coronary Angiography - statistics & numerical data; Datasets as Topic; Female; health services research; Heart Arrest - epidemiology; Hospital Mortality; Hospitalization; Humans; Male; Medicaid - statistics & numerical data; Medically Uninsured - statistics & numerical data; Medicare - statistics & numerical data; Middle Aged; Original Research; Percutaneous Coronary Intervention - statistics & numerical data; quality of care; race and ethnicity; Racial Groups - statistics & numerical data; Renal Dialysis - statistics & numerical data; Respiration, Artificial - statistics & numerical data; United States - epidemiology; United States; health services research; acute coronary syndrome; quality of care; race and ethnicity
• ISSN: 2047-9980; 2047-9980
• DOI: 10.1161/JAHA.119.012831

Background Patient characteristics insufficiently explain disparities in cardiovascular outcomes among hospitalized patients, suggesting a role for community or hospital-level factors. Here, we evaluate the association of hospital racial composition and payer mix with all-cause inpatient mortality for patients hospitalized with acute coronary syndrome (ACS). Methods and Results Using the National Inpatient Sample, we identified adult hospitalizations from 2014 with a primary diagnosis of ACS (n=550 005). We divided National Inpatient Sample hospitals into quartiles based on percent of minority (black, Hispanic, Asian or Pacific Islander, Native American race/ethnicity) and low-income payer (Medicaid or uninsured) discharges in 2014. We utilized logistic regression to determine whether hospital minority or low-income payer makeup associated with all-cause inpatient mortality among those admitted for ACS . In adjusted models, ACS patients admitted to hospitals with >12.4% to 25.4% (Quartile 2), >25.4% to 44.3% (Q3), and >44.3% (Q4) minority discharges experienced a 14% (OR 1.14, 95% CI 1.06-1.23), 13% (OR 1.13, 95% CI 1.04-1.23), and 15% (OR 1.15, 95% CI 1.04-1.26) increased odds of all-cause inpatient mortality compared with hospitals with ≤12.4% (Q1) minority discharges. ACS patients admitted to hospitals with >18.7% to 25.7% (Q2) and >34.0% (Q4) low-income payer discharges experienced a 9% (OR 1.09, 1.01-1.17) and 9% (OR 1.09, 1.00-1.19) increased odds of all-cause inpatient mortality when compared with hospitals with ≤18.7% (Q1) low-income payer discharges. Conclusions Hospital minority and low-income payer makeup positively associate with odds of all-cause inpatient mortality among patients admitted for acute coronary syndrome.