INFLUENCE OF RACE AND GENDER ON CARE PROCESS, RESOURCE USE, AND HOSPITAL-BASED OUTCOMES IN CONGESTIVE-HEART-FAILURE

Race and gender are important determinants of certain clinical outcome s in cardiovascular disease. To examine the influence of race and gend er on care process, resource use, and hospital-based case outcomes for patients with congestive heart failure (CHF), we obtained administrat ive records on all 1995 New York State hospital discharges assigned IC D-9-CM codes indicative of this diagnosis. The following were compared among black and white women and men: demographics, comorbid illness, care processes, length of stay (LOS), hospital charges, mortality rate , and CHF readmission rate. We identified 45,894 patients (black women , 4,750; black men, 3,370; white women, 21,165; white men, 16,609). Bl acks underwent noninvasive cardiac procedures more often than whites; procedure and specialty use rates were lower among women than among me n. After adjusting for other patient characteristics and hospital type and location, we found race to be an important determinant of LOS (bl ack, 10.4 days; white, 9.3 days; p = 0.0001), hospital charges (black, $13,711; white, $11,074; p = 0.0001), mortality (black-to-white odds ratio = 0.832; p = 0.003), and readmission (black-to-white odds ratio = 1.301; p 0.0001). Gender was an important determinant of LOS (women, 9.8 days; men, 9.2 days; p = 0.0001), hospital charges (women, $11,69 0; men, $11,348; p = 0.02), and mortality (women-to-men odds ratio = 0 .878; p 0.0008). We conclude that race and gender influence care proce ss and hospital-based case outcomes for patients with CHF. (C) 1998 by Excerpta Medica, Inc.