Geographic Variations in Heart Failure Hospitalizations Among Medicare Beneficiaries in the Tennessee Catchment Area

Abstract

Introduction Although differences in heart failure hospitalization rates by race and sex are well documented, little is known about geographic variations in hospitalization rates for heart failure among Medicare beneficiaries. Methods Using exploratory spatial data analysis techniques, we examined hospitalization rates for heart failure as the first-listed discharge diagnosis among Medicare beneficiaries in a 10-state Tennessee catchment area, based on the resident states reported by Tennessee hospitals from 2000 to 2004. Results The age-adjusted heart failure hospitalization rate (per 1,000) among Medicare beneficiaries was 23.3 (95% confidence interval [CI], 23.3–23.4) for the Tennessee catchment area, 21.4 (95% CI, 21.4 -21.5) for the non-catchment US area and 21.9 (95% CI, 21.9–22.0) for the overall US. The age-adjusted HF hospitalization rates were also significantly higher in the catchment area than the non catchment US area and the overall US, among men, women, and whites, whereas rates among the blacks were higher outside the catchment area. Beneficiaries in the catchment area also had higher age-specific HF hospitalization rates. Among states in the catchment area, the highest mean county-level rates were in Mississippi (30.6±7.6) and Kentucky (29.2±11.5), and the lowest were in North Carolina (21.7±5.7), closely and Virginia (21.8±6.6). Conclusions Knowledge of geographic differences in rates of hospitalization for heart failure can be useful in identifying needs of health care providers, allocating resources, developing comprehensive heart failure outreach programs, and formulating policies designed to reduce these differences.

Regional differences in heart failure hospitalizations, mortality, and readmissions in Slovenia 2004–2012

“…Europe) but is also seen on a national level . In the USA, similar observations have been reported: lower socio‐economic status and lower number of primary care physicians per inhabitant were related to higher mortality rates at level of counties and states …”

“…showed that most of the HF hospitalization burden came from specific areas in the USA with the highest prevalence of risk factors for CV disease. Furthermore, Ogunniyi et al ., in the study in Medicare beneficiaries hospitalized due to HF in Tennessee catchment area, reported that counties with higher HF hospitalization rates were in general those with lower primary care physician to Medicare beneficiaries ratio and that HF hospitalization rates were higher in rural counties. On the other hand, European study investigating potentially avoidable hospitalizations in the Spanish regions of Castile and Leon found the opposite .…”

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National trends in heart failure hospitalization rates in Slovenia 2004–2012

“…Moreover, a recent analysis of a French nationwide database challenges such a standpoint, as no decline in standardized HF hospitalization rates was identified. It should be emphasized that, globally, national studies are few; most studies are either limited to a particular geographical region within a country, are part of or derived from a multicentre registry, or do not represent a nationwide sample …”