Heart failure & cardiomyopathies
Hospital Referral Region Dissimilarity and Black-White Differences in Heart Failure Outcomes Among Medicare Beneficiaries
Authors' conclusion
In this nationally representative HF cohort, Black patients had a lower hazard of mortality across all HRRs compared to White patients. However, rehospitalization risk was significantly higher for Black patients than for White patients who received care in more highly segregated regions.
Study context
- Population
- Medicare beneficiaries hospitalised for heart failure (HF), discharged 2017–2018, followed up to March 2020; HRR segregation by dissimilarity index (DI) tertiles
- Participants
- 513,846 beneficiaries201 hospital referral regions (HRRs)
- Exposure
- Black vs White patients with HF, by HRR segregation tertile
- Outcome
- Mortality (survival from admission) and HF rehospitalization (mortality as competing event)
Methodological detailsnationally representative, US Medicare 100% files, mixed-effects Cox models
- Nationally representative
- US Medicare 100% files
- Mixed-effects Cox models
Main finding
As reported in the abstract
Black vs White, by HRR segregation tertile
Black vs WhiteHazard ratio (95% CI)
Mortality, low segregation; adjusted
0.91(0.89–0.93)
Mortality, medium segregation; adjusted
0.90(0.88–0.92)
Mortality, high segregation; adjusted
0.90(0.88–0.91)
HF hospitalization, low segregation; adjusted
1.03(0.97–1.09)
HF hospitalization, medium segregation; adjusted
1.14(1.08–1.20)
HF hospitalization, high segregation; adjusted
1.21(1.16–1.26)
Observational data: associations, not effects.
Original publication
Hospital Referral Region Dissimilarity and Black-White Differences in Heart Failure Outcomes Among Medicare Beneficiaries. JACC Heart Fail. Published 30 July 2026. doi:10.
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