Impact of Race on Health Care Utilization and Outcomes in Veterans with Congestive Heart Failure

Houston Center for Quality of Care and Utilization Studies, Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas 77030, USA.
Journal of the American College of Cardiology (Impact Factor: 16.5). 04/2004; 43(5):778-84. DOI: 10.1016/j.jacc.2003.10.033
Source: PubMed

ABSTRACT The objectives of this study were to determine racial differences in mortality in a national cohort of patients hospitalized with congestive heart failure (CHF) within a financially "equal-access" healthcare system, the Veterans Health Administration (VA), and to examine racial differences in patterns of healthcare utilization following hospitalization.
To explain the observed paradox of increased readmissions and lower mortality in black patients hospitalized with CHF, it has been postulated that black patients may have reduced access to outpatient care, resulting in a higher number of hospital admissions for lesser disease severity.
In a retrospective study of 4,901 black and 17,093 white veterans hospitalized with CHF in 153 VA hospitals, we evaluated mortality at 30 days and 2 years, and healthcare utilization in the year following discharge.
The risk-adjusted odds ratios (OR) for 30-day and 2-year mortality in black versus white patients were 0.70 (95% confidence interval [CI] 0.60 to 0.82) and 0.84 (95% CI 0.78 to 0.91), respectively. In the year following discharge, blacks had the same rate of readmissions as whites. Blacks had a lower rate of medical outpatient clinic visits and a higher rate of urgent care/emergency room visits than whites, although these differences were small.
In a system where there is equal access to healthcare, the racial gap in patterns of healthcare utilization is small. The observation of better survival in black patients after a CHF hospitalization is not readily explained by differences in healthcare utilization.

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    • "In the VA, recent studies have documented a smaller treatment gap between whites and minority groups (Kressin et al., 2007). Other studies (Deswal et al., 2004) even showed better mortality outcomes in black versus white veterans in six conditions (Volpp et al., 2007) and no difference in access regarding utilization for veterans with bipolar disorder (Zeber et al., in press) suggesting that an ''equal access'' system such as the VA lessens disparities. Our study suggests that there is differential healthcare utilization, by race, of neurology specialty care despite having access to two healthcare systems—VA and Medicare . "
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    • "Thiamine deficiency also is prevalent in both Type I and Type II diabetes, with patients showing 76% reduced thiamine levels (Thornalley et al., 2007), likely resulting from frequent urination with loss of essential nutrition (Drivsholm et al., 2005). HF patients have a high incidence of diabetes, up to 48% in hospitalized HF patients (Deswal et al., 2004; Rathore et al., 2003); up to 22% of diabetic patients develop HF in older ages (Bertoni et al., 2004; Thrainsdottir et al., 2005). High glucose levels induce tissue injury (Vincent et al., 2002), and thiamine protects cells, axons, and the vasculature system against increased levels of glucose (Thornalley, 2005). "
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