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Odds of Hospital Readmission 34% Higher for Black Heart Attack Patients

Social determinants of health explained only 21 percent of the racial disparities in hospital readmission rates for Black heart attack patients, the researchers noted.

The risk of hospital readmission after a heart attack is markedly higher for Black people than White, a trend researchers said in JAMA Network Open should prompt further investigation into how systemic racism and the social determinants of health affect these racial health disparities.

These findings challenge medical theories stating that racial differences in heart attack outcomes can be explained away by disproportionate social determinants of health burden. Black people are more likely to experience SDOH and have other comorbidities, conventional wisdom has stated, which some have theorized can explain the differences in heart attack outcomes.

But SDOH are just part of the problem, this latest study found. After controlling for social factors and other comorbidities, researchers found that the racial disparities in hospital readmission following a heart attack are persistent.

The researchers looked at just shy of 3,000 younger adults ages 18 to 55 who had experienced an acute myocardial infarction (AMI), or heart attack, to track whether they had been readmitted back into the hospital after receiving care for the AMI.

When looking at unadjusted data, the researchers saw that Black people, particularly Black women, were more likely to experience hospital readmission. The hospital readmission rate for all Black people was 39.4 percent compared to 28.8 percent for White people. That amounts to a 61 percent greater odds of being readmitted to the hospital, the researchers said.

Those differences are the result of numerous factors, including social determinants of health. Those with low income, limited social support, and higher self-reported stress levels were more likely to be readmitted, and those SDOHs were more prevalent among Black folks than White.

But those SDOHs don’t tell the whole story; in fact, SDOHs can only explain 21 percent of the racial disparities in one-year hospital readmission rates for AMI patients. And when controlling for social determinants of health—plus comorbidities and sociodemographics—those disparities in readmission still hold up.

The adjusted risk for hospital readmission among Black people was still 34 percent higher than for White people, even after controlling for some factors, the researchers reported.

“Qualitative work on AMI survivorship has conceptualized the recovery process as a deeply personal, unique process associated with daily functioning, which may result in changes in SDOHs, such as employment status, psychological stress, and perceived social support,” the researchers explained.

“Our findings necessitate further research to explore other unmeasured factors that explain the racial differences in readmission at 1 year, including structural racism and implicit bias, as well as more focus on addressing these upstream influences,” they continued.

There were some other factors outside race that could predict hospital readmission after AMI, including a diabetes diagnosis, history of depression, kidney disease, history of heart attack, and limited physical activity. The researchers said healthcare providers may use these figures to risk-stratify their patient engagement efforts and conduct more extensive patient follow-ups with these groups.

The researchers also observed some gender disparities in hospital readmission, particularly among young Black women. This population was more likely to be readmitted to the hospital within a year of having a heart attack, with nearly half of Black women included in the study experiencing a hospital readmission.

“Our findings call for a more in-depth understanding of how intersecting identities, such as race, ethnicity, and biological sex, come together to impact health outcomes, especially as they relate to cardiovascular health and AMI specifically,” the researchers indicated.

That’s the researchers’ conclusion moving forward in general, they indicated. Nearly 80 percent of the racial disparities in one-year hospital readmission among heart attack patients is left unexplained, they said, so future research needs to uncover those underlying factors. In doing so, the medical community can make efforts to augment patient engagement and follow-up care to prevent readmission.

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