The objectives of this study were to determine (1) how congestive heart failure (CHF) hospitalization rates may differ according to race/ethnicity, (2) whether racial differences in likelihood of rehospitalization may explain a portion of the potential race and ethnic variation in annual rates of CHF hospitalization, and (3) whether survival after hospitalization for CHF differed among racial/ethnic groups.

The data for this study were derived from a customized version of the confidential California hospital discharge abstracts (from the California Office of Statewide Health Planning and Development) and from the California Vital Statistics death registry. Patients at least 18 years old and hospitalized for CHF during the years 1991 and 1992 were identified.

The population-based incidence of hospital admissions for CHF in California in 1991 was estimated. African American men and women had the highest overall age-adjusted rates of hospitalization (62.6 and 45.4 per 10,000 respectively). The rates were similar for white, Latino, and Asian men and women (with the exception of the relatively lower rates among Asian men). When these analyses were conducted for individual patients (rather than hospital admissions), the relative patterns across racial/ethnic group changed only slightly. The rate ratios for African Americans and Latinos compared with whites were slightly lower than in the previous analyses, indicating that these racial/ethnic groups were more likely than whites to be rehospitalized.

Patients hospitalized in either 1991 or 1992 were followed for a 12-month period from the time of the first hospitalization during this period in order to estimate the likelihood of rehospitalization or death. Rehospitalization was higher for African Americans (24.5% were rehospitalized) and Latinos (23.4% were rehospitalized) than for Asians (19.6% were rehospitalized) and whites (19.9% were rehospitalized). Several measures of rehospitalization – rehospitalization with CHF as the primary diagnosis, rehospitalization for any diagnosis, number of rehospitalizations, days in the hospital, and total hospital charged – revealed the same pattern. After adjusting for survival and baseline clinical, demographic and insurance characteristics, the risk of rehospitalization (for any diagnosis) relative to whites was 1.07 (95% confidence interval=1.04-1.10) for African Americans, 1.02 (95% confidence interval=0.99-1.05) for Hispanics, and 0.96 (95% confidence interval=0.92-1.00) for Asians.

Interestingly, mortality rates during the 12 months after the index CHD hospitalization were lower for African Americans (25.4% died) and Latinos (25.5% died) than whites (34.2% died) and Asians (29.4% died). The pattern was the same after adjusting for baseline clinical, demographic and insurance characteristics.

Four explanations for the “paradoxical findings” of higher rehospitalization rates and lower mortality rates among African Americans compared with other racial/ethnic groups were offered. The severity and the underlying pathophysiology of heart failure may differ across race/ethnic groups. Access to care and quality of care may differ according to race/ethnic group, leading to more hospitalizations among African Americans and Latinos that might have been prevented by timely and effective ambulatory care. Finally, the patterns might have been caused by an interaction between lower disease severity and poorer access to care among African Americans and Latinos.