Disparate Cardiovascular Hospitalization Trends Among Young and Middle-Aged Adults Within and Across Race and Ethnicity Groups in Four States in the United States

Ehimare Akhabue; Melanie Rua; Poonam Gandhi; Jung Hyun Kim; Joel C. Cantor; Soko Setoguchi

doi:https://doi.org/10.1161/JAHA.122.027342

Disparate Cardiovascular Hospitalization Trends Among Young and Middle-Aged Adults Within and Across Race and Ethnicity Groups in Four States in the United States

Ehimare Akhabue, Melanie Rua, Poonam Gandhi, Jung Hyun Kim, Joel C. Cantor, Soko Setoguchi

Rutgers, The State University

Research output: Contribution to journal › Article › peer-review

Abstract

BACKGROUND: Inpatient hospitalizations for cardiovascular disease (CVD) decreased nationally in the past decade. However, data are lacking on whether national declines represent trends within and across race and ethnicity populations from different US regions. METHODS AND RESULTS: Using State Inpatient Databases, Census Bureau and Behavioral Risk Factor Surveillance System data for Florida, Kentucky, New Jersey, and North Carolina, we identified all CVD hospitalizations and population characteristics for adults aged 18 to 64 years between January 1, 2009 and December 31, 2018. We calculated yearly CVD hospitalization rates for each state for the overall population, by sex, race, and ethnicity. We modeled yearly trends in age-adjusted CVD hospitalization rate in each state using negative binomial regression. State base populations were similar by age (mean age: 40– 42 years) and sex (50%– 51% female) throughout the study period. There were 314 973 and 288 843 total CVD hospitalizations among the 4 states in 2009 and 2018, respectively. Crude hospitalization rates declined in all states (age 18– 44 years NJ: −33.4%; KY: −17.0%; FL: −11.9%; NC: −11.2%; age 45– 64 years NJ: −29.8%; KY: −20.3%; FL: −12.2%; NC: −11.6%) over the study period. In age-adjusted models, overall hospitalization rates declined significantly in NJ −2.5%/y (95% CI, −2.9 to −2.1) and in KY −1.6%/y (−1.9 to −1.2) with no significant declining trend in FL and NC. Similar findings were present by sex. Among non-Hispanic White populations, mean yearly decline in hospitalization rate was significant in all states except FL, with the greatest declines in NJ (−3.8%/y [−4.4 to −3.2], P values for state−year interaction <0.0001). By contrast, a significant declining trend was present for non-Hispanic Black and Hispanic populations only in NJ (P values for state−year interaction <0.001). We found similar differences in trend between states in sensitivity analyses incorporating additional demographic and comorbid characteristics. CONCLUSIONS: Decreases in CVD hospitalization rates in the past decade among nonelderly adults varied considerably by state and appeared largely driven by declines among non-Hispanic White populations. Overall declines did not represent divergent trends between states within non-Hispanic Black and Hispanic populations. Recognition of differences not just between but also within race and ethnicity populations should inform national and local policy initiatives aimed at reducing disparities in CVD outcomes.

Original language	English (US)
Article number	e7978
Journal	Journal of the American Heart Association
Volume	12
Issue number	1
DOIs	https://doi.org/10.1161/JAHA.122.027342
State	Published - Jan 3 2023

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine

Keywords

behavioral risk factor surveillance system
cardiovascular epidemiology
cardiovascular hospitalization
health disparities
health policy
middle-aged adult
young adult

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https://doi.org/10.1161/JAHA.122.027342

Cite this

@article{5b1958125b7a4f93b7c82a616c7586ad,

title = "Disparate Cardiovascular Hospitalization Trends Among Young and Middle-Aged Adults Within and Across Race and Ethnicity Groups in Four States in the United States",

abstract = "BACKGROUND: Inpatient hospitalizations for cardiovascular disease (CVD) decreased nationally in the past decade. However, data are lacking on whether national declines represent trends within and across race and ethnicity populations from different US regions. METHODS AND RESULTS: Using State Inpatient Databases, Census Bureau and Behavioral Risk Factor Surveillance System data for Florida, Kentucky, New Jersey, and North Carolina, we identified all CVD hospitalizations and population characteristics for adults aged 18 to 64 years between January 1, 2009 and December 31, 2018. We calculated yearly CVD hospitalization rates for each state for the overall population, by sex, race, and ethnicity. We modeled yearly trends in age-adjusted CVD hospitalization rate in each state using negative binomial regression. State base populations were similar by age (mean age: 40– 42 years) and sex (50%– 51% female) throughout the study period. There were 314 973 and 288 843 total CVD hospitalizations among the 4 states in 2009 and 2018, respectively. Crude hospitalization rates declined in all states (age 18– 44 years NJ: −33.4%; KY: −17.0%; FL: −11.9%; NC: −11.2%; age 45– 64 years NJ: −29.8%; KY: −20.3%; FL: −12.2%; NC: −11.6%) over the study period. In age-adjusted models, overall hospitalization rates declined significantly in NJ −2.5%/y (95% CI, −2.9 to −2.1) and in KY −1.6%/y (−1.9 to −1.2) with no significant declining trend in FL and NC. Similar findings were present by sex. Among non-Hispanic White populations, mean yearly decline in hospitalization rate was significant in all states except FL, with the greatest declines in NJ (−3.8%/y [−4.4 to −3.2], P values for state−year interaction <0.0001). By contrast, a significant declining trend was present for non-Hispanic Black and Hispanic populations only in NJ (P values for state−year interaction <0.001). We found similar differences in trend between states in sensitivity analyses incorporating additional demographic and comorbid characteristics. CONCLUSIONS: Decreases in CVD hospitalization rates in the past decade among nonelderly adults varied considerably by state and appeared largely driven by declines among non-Hispanic White populations. Overall declines did not represent divergent trends between states within non-Hispanic Black and Hispanic populations. Recognition of differences not just between but also within race and ethnicity populations should inform national and local policy initiatives aimed at reducing disparities in CVD outcomes.",

keywords = "behavioral risk factor surveillance system, cardiovascular epidemiology, cardiovascular hospitalization, health disparities, health policy, middle-aged adult, young adult",

author = "Ehimare Akhabue and Melanie Rua and Poonam Gandhi and Kim, {Jung Hyun} and Cantor, {Joel C.} and Soko Setoguchi",

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doi = "https://doi.org/10.1161/JAHA.122.027342",

language = "English (US)",

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T1 - Disparate Cardiovascular Hospitalization Trends Among Young and Middle-Aged Adults Within and Across Race and Ethnicity Groups in Four States in the United States

AU - Akhabue, Ehimare

AU - Rua, Melanie

AU - Gandhi, Poonam

AU - Kim, Jung Hyun

AU - Cantor, Joel C.

AU - Setoguchi, Soko

PY - 2023/1/3

Y1 - 2023/1/3

N2 - BACKGROUND: Inpatient hospitalizations for cardiovascular disease (CVD) decreased nationally in the past decade. However, data are lacking on whether national declines represent trends within and across race and ethnicity populations from different US regions. METHODS AND RESULTS: Using State Inpatient Databases, Census Bureau and Behavioral Risk Factor Surveillance System data for Florida, Kentucky, New Jersey, and North Carolina, we identified all CVD hospitalizations and population characteristics for adults aged 18 to 64 years between January 1, 2009 and December 31, 2018. We calculated yearly CVD hospitalization rates for each state for the overall population, by sex, race, and ethnicity. We modeled yearly trends in age-adjusted CVD hospitalization rate in each state using negative binomial regression. State base populations were similar by age (mean age: 40– 42 years) and sex (50%– 51% female) throughout the study period. There were 314 973 and 288 843 total CVD hospitalizations among the 4 states in 2009 and 2018, respectively. Crude hospitalization rates declined in all states (age 18– 44 years NJ: −33.4%; KY: −17.0%; FL: −11.9%; NC: −11.2%; age 45– 64 years NJ: −29.8%; KY: −20.3%; FL: −12.2%; NC: −11.6%) over the study period. In age-adjusted models, overall hospitalization rates declined significantly in NJ −2.5%/y (95% CI, −2.9 to −2.1) and in KY −1.6%/y (−1.9 to −1.2) with no significant declining trend in FL and NC. Similar findings were present by sex. Among non-Hispanic White populations, mean yearly decline in hospitalization rate was significant in all states except FL, with the greatest declines in NJ (−3.8%/y [−4.4 to −3.2], P values for state−year interaction <0.0001). By contrast, a significant declining trend was present for non-Hispanic Black and Hispanic populations only in NJ (P values for state−year interaction <0.001). We found similar differences in trend between states in sensitivity analyses incorporating additional demographic and comorbid characteristics. CONCLUSIONS: Decreases in CVD hospitalization rates in the past decade among nonelderly adults varied considerably by state and appeared largely driven by declines among non-Hispanic White populations. Overall declines did not represent divergent trends between states within non-Hispanic Black and Hispanic populations. Recognition of differences not just between but also within race and ethnicity populations should inform national and local policy initiatives aimed at reducing disparities in CVD outcomes.

AB - BACKGROUND: Inpatient hospitalizations for cardiovascular disease (CVD) decreased nationally in the past decade. However, data are lacking on whether national declines represent trends within and across race and ethnicity populations from different US regions. METHODS AND RESULTS: Using State Inpatient Databases, Census Bureau and Behavioral Risk Factor Surveillance System data for Florida, Kentucky, New Jersey, and North Carolina, we identified all CVD hospitalizations and population characteristics for adults aged 18 to 64 years between January 1, 2009 and December 31, 2018. We calculated yearly CVD hospitalization rates for each state for the overall population, by sex, race, and ethnicity. We modeled yearly trends in age-adjusted CVD hospitalization rate in each state using negative binomial regression. State base populations were similar by age (mean age: 40– 42 years) and sex (50%– 51% female) throughout the study period. There were 314 973 and 288 843 total CVD hospitalizations among the 4 states in 2009 and 2018, respectively. Crude hospitalization rates declined in all states (age 18– 44 years NJ: −33.4%; KY: −17.0%; FL: −11.9%; NC: −11.2%; age 45– 64 years NJ: −29.8%; KY: −20.3%; FL: −12.2%; NC: −11.6%) over the study period. In age-adjusted models, overall hospitalization rates declined significantly in NJ −2.5%/y (95% CI, −2.9 to −2.1) and in KY −1.6%/y (−1.9 to −1.2) with no significant declining trend in FL and NC. Similar findings were present by sex. Among non-Hispanic White populations, mean yearly decline in hospitalization rate was significant in all states except FL, with the greatest declines in NJ (−3.8%/y [−4.4 to −3.2], P values for state−year interaction <0.0001). By contrast, a significant declining trend was present for non-Hispanic Black and Hispanic populations only in NJ (P values for state−year interaction <0.001). We found similar differences in trend between states in sensitivity analyses incorporating additional demographic and comorbid characteristics. CONCLUSIONS: Decreases in CVD hospitalization rates in the past decade among nonelderly adults varied considerably by state and appeared largely driven by declines among non-Hispanic White populations. Overall declines did not represent divergent trends between states within non-Hispanic Black and Hispanic populations. Recognition of differences not just between but also within race and ethnicity populations should inform national and local policy initiatives aimed at reducing disparities in CVD outcomes.

KW - behavioral risk factor surveillance system

KW - cardiovascular epidemiology

KW - cardiovascular hospitalization

KW - health disparities

KW - health policy

KW - middle-aged adult

KW - young adult

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JO - Journal of the American Heart Association

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Disparate Cardiovascular Hospitalization Trends Among Young and Middle-Aged Adults Within and Across Race and Ethnicity Groups in Four States in the United States

Abstract

ASJC Scopus subject areas

Keywords

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