Background:Socioeconomic disadvantage is a strong determinant of adverse outcomes in patients with heart failure. However, the contribution of community-level economic distress to adverse outcomes in heart failure may differ across races and ethnicities.Methods:Patients of self-reported Black, White, and Hispanic race and ethnicity hospitalized with heart failure between 2014 and 2019 were identified from the Medicare MedPAR Part A 100% Files. We used patient-level residential ZIP code to quantify community-level economic distress on the basis of the Distressed Community Index (quintile 5: economically distressed versus quintiles 1–4: nondistressed). The association of continuous and categorical measures (distressed versus nondistressed) of Distressed Community Index with 30-day, 6-month, and 1-year risk-adjusted mortality, readmission burden, and home time were assessed separately by race and ethnicity groups.Results:The study included 1 611 586 White (13.2% economically distressed), 205 840 Black (50.6% economically distressed), and 89 199 Hispanic (27.3% economically distressed) patients. Among White patients, living in economically distressed (versus nondistressed) communities was significantly associated with a higher risk of adverse outcomes at 30-day and 1-year follow-up. Among Black and Hispanic patients, the risk of adverse outcomes associated with living in distressed versus nondistressed communities was not meaningfully different at 30 days and became more prominent by 1-year follow-up. Similarly, in the restricted cubic spline analysis, a stronger and more graded association was observed between Distressed Community Index score and risk of adverse outcomes in White patients (versus Black and Hispanic patients). Furthermore, the association between community-level economic distress and risk of adverse outcomes for Black patients differed in rural versus urban areas. Living in economically distressed communities was significantly associated with a higher risk of mortality and lower home time at 1-year follow-up in rural areas but not urban areas.Conclusions:The association between community-level economic distress and risk of adverse outcomes differs across race and ethnic groups, with a stronger association noted in White patients at short- and long-term follow-up. Among Black patients, the association of community-level economic distress with a higher risk of adverse outcomes is less evident in the short term and is more robust and significant in the long-term follow-up and rural areas.

中文翻译：

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Medicare 受益人心力衰竭住院后的社区经济困境、种族和不良后果风险

背景：社会经济劣势是心力衰竭患者不良结局的重要决定因素。然而，社区层面的经济困难对心力衰竭不良结局的贡献可能因种族和种族而异。 Medicare MedPAR A 部分 100% 文件。我们使用患者级别的住宅邮政编码，根据贫困社区指数（五分位 5：经济困难与五分位 ​​1-4：非贫困）量化社区水平的经济困难。不良社区指数的连续和分类测量（不良与非不良）与 30 天、6 个月和 1 年风险调整死亡率、再入院负担、和家庭时间分别按种族和族裔群体进行评估。结果：该研究包括 1 611 586 名白人（13.2% 经济困难）、205 840 名黑人（50.6% 经济困难）和 89 199 名西班牙裔（27.3% 经济困难）患者。在白人患者中，在 30 天和 1 年的随访中，生活在经济困难（相对于非困难）社区的人与更高的不良后果风险显着相关。在黑人和西班牙裔患者中，与生活在贫困社区和非贫困社区相关的不良后果风险在 30 天时没有显着差异，并且在 1 年随访时变得更加突出。同样，在受限三次样条分析中，在白人患者（相对于黑人和西班牙裔患者）的不良社区指数评分与不良后果风险之间观察到更强和更分级的关联。此外，社区层面的经济困境与黑人患者不良后果风险之间的关联在农村地区与城市地区有所不同。在农村地区而非城市地区的 1 年随访中，生活在经济困难的社区与较高的死亡率风险和较短的家庭时间显着相关。结论：社区层面的经济困难与不良后果风险之间的关联因人而异种族和族裔群体，在短期和长期随访中发现白人患者有更强的关联。在黑人患者中，