Rural disparities in end‐of‐life care for patients with heart failure: Are they due to geography or socioeconomic disparity?

Hutchinson, Rebecca; Han, Paul K. J.; Lucas, F. Lee; Black, Adam; Sawyer, Douglas B.; Fairfield, Kathleen M.

doi:10.1111/jrh.12597

Cited by 7 publications

(8 citation statements)

References 44 publications

(100 reference statements)

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“…Access to health care is a societal driver of rural-urban disparities and is singled out as a top priority in the Rural Healthy People 2020 report . Differing access to care in rural areas can negatively influence health outcomes; specifically within HF after diagnosis, rural patients have a longer delay in care and reduced emergency department visits, hospitalizations, and hospice use . In addition to affecting outcomes, access to care can affect disease incidence because of inequities in levels of preventive care and risk factor management.…”

Section: Discussionmentioning

confidence: 99%

“…32 Differing access to care in rural areas can negatively influence health outcomes; specifically within HF after diagnosis, rural patients have a longer delay in care and reduced emergency department visits, hospitalizations, and hospice use. 10,33,34 In addition to affecting outcomes, access to care can affect disease incidence because of inequities in levels of preventive care and risk factor management. Future research should examine the impact of preventive care utilization on risk of HF and chronic disease among rural residents.…”

Section: Rurality and Hfmentioning

confidence: 99%

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Association of Rurality With Risk of Heart Failure

Turecamo

Dixon

et al. 2023

JAMA Cardiol

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ImportanceRural populations experience an increased burden of heart failure (HF) mortality compared with urban populations. Whether HF incidence is greater among rural individuals is less known. Additionally, the intersection between racial and rural health inequities is understudied.ObjectiveTo determine whether rurality is associated with increased risk of HF, independent of cardiovascular (CV) disease and socioeconomic status (SES), and whether rurality-associated HF risk varies by race and sex.Design, Setting, and ParticipantsThis prospective cohort study analyzed data for Black and White participants of the Southern Community Cohort Study (SCCS) without HF at enrollment who receive care via Centers for Medicare &amp; Medicaid Services (CMS). The SCCS is a population-based cohort of low-income, underserved participants from 12 states across the southeastern United States. Participants were enrolled between 2002 and 2009 and followed up until December 31, 2016. Data were analyzed from October 2021 to November 2022.ExposuresRurality as defined by Rural-Urban Commuting Area codes at the census-tract level.Main Outcomes and MeasuresHeart failure was defined using diagnosis codes via CMS linkage through 2016. Incidence of HF was calculated by person-years of follow-up and age-standardized. Sequentially adjusted Cox proportional hazards regression models tested the association between rurality and incident HF.ResultsAmong 27 115 participants, the median (IQR) age was 54 years (47-65), 18 647 (68.8%) were Black, and 8468 (32.3%) were White; 5556 participants (20%) resided in rural areas. Over a median 13-year follow-up, age-adjusted HF incidence was 29.6 (95% CI, 28.9-30.5) per 1000 person-years for urban participants and 36.5 (95% CI, 34.9-38.3) per 1000 person-years for rural participants (P &lt; .001). After adjustment for demographic information, CV risk factors, health behaviors, and SES, rural participants had a 19% greater risk of incident HF (hazard ratio [HR], 1.19; 95% CI, 1.13-1.26) compared with their urban counterparts. The rurality-associated risk of HF varied across race and sex and was greatest among Black men (HR, 1.34; 95% CI, 1.19-1.51), followed by White women (HR, 1.22; 95% CI, 1.07-1.39) and Black women (HR, 1.18; 95% CI, 1.08-1.28). Among White men, rurality was not associated with greater risk of incident HF (HR, 0.97; 95% CI, 0.81-1.16).Conclusions and RelevanceAmong predominantly low-income individuals in the southeastern United States, rurality was associated with an increased risk of HF among women and Black men, which persisted after adjustment for CV risk factors and SES. This inequity points to a need for additional emphasis on primary prevention of HF among rural populations.

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Section: Discussionmentioning

confidence: 99%

Section: Rurality and Hfmentioning

confidence: 99%

Association of Rurality With Risk of Heart Failure

Turecamo

Dixon

et al. 2023

JAMA Cardiol

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“…Studies have found rural patients were less likely to receive hospice care than urban patients. 8,19,20 Racial disparity in hospice use persists regardless of geographic residence. For example, a study on lung cancer patients' use of hospice care reported that African-Americans were 21% less likely to use hospice care than Whites in both rural and urban areas.…”

Section: Disparity Of Hospice Awareness and Hospice Use Among African...mentioning

confidence: 99%

Awareness of Hospice Care Among Rural African-Americans: Findings From Social Determinants of Health Framework

Noh

Lee

et al. 2021

Am J Hosp Palliat Care

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Background: Despite the need for hospice care as our society ages, adults in the U.S.’s southern rural region have limited awareness of hospice care. Objective: This study aims to assess the rate of awareness of hospice care among rural residents living in Alabama’s Black Belt region and examine social determinants of health (SDH) associated with the awareness. Methods: A cross-sectional survey was conducted among a convenience sample living in Alabama’s Black Belt region (N = 179, age = 18-91). Participants’ awareness of hospice care, demographic characteristics (ie, age and gender), and SDH (ie, financial resources strain, food insecurity, education and health literacy, social isolation, and interpersonal safety) were assessed. Lastly, a binary logistic regression was used to examine the association between SDH and hospice awareness among participants while controlling for demographic characteristics. Results: The majority of participants had heard of hospice care (n = 150, 82.1%), and older participants (50 years old or older) were more likely to report having heard of hospice care ( OR = 7.35, P < 0.05). Participants reporting worries about stable housing (OR = 0.05, P < 0.05) and higher social isolation were less likely to have heard of hospice care ( OR = 0.53, P < 0.05), while participants with higher health literacy had a higher likelihood to have heard of it ( OR = 2.60, P < 0.01). Conclusions: Our study is the first study assessing the status of hospice awareness among residents of Alabama’s Black Belt region. This study highlighted that factors including age and certain SDH (ie, housing status, health literacy, and social isolation) might be considered in the intervention to improve hospice awareness.

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“…In addition to racialized populations receiving poorer end‐of‐life care, other social determinants of health also contribute to inequities. Individuals with limited access to health care due to geographic location, and those with lower socioeconomic status are also known to receive inequitable end‐of‐life care (Hutchinson et al, 2021; Noh et al, 2021).…”

Section: Introductionmentioning

confidence: 99%

“…Though some studies have been conducted on health inequities in end‐of‐life care and how to promote health equity by addressing social determinants of health (Bazargan & Bazargan‐Hejazi, 2021; Brown et al, 2018; Hutchinson et al, 2021; Noh et al, 2021), progress is hampered by complex and multi‐faceted nature of both end‐of‐life care and social determinants of health (Alvidrez et al, 2019). End‐of‐life care requires holistic and individualized approaches in response to physical, psychological, social and spiritual needs through a multidisciplinary team (Finucane et al, 2021; Nelson et al, 2021).…”

Section: Introductionmentioning

confidence: 99%

A comparison of conceptual frameworks to examine health inequities in End‐of‐Life care

Kang

Barcelona

2022

Journal of Advanced Nursing

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Aims:To discuss existing conceptual frameworks that can be applied to the examination of health inequities in end-of-life care and related health outcomes. We used the Fawcett and Desanto-Madeya evaluation technique modified by the National Institute on Minority Health and Health Disparities Research Framework to include individual, interpersonal, community, and societal levels of influence.Design: Discussion paper. Data sources:We performed a systematic review of PubMed, CINAHL and Embase for conceptual frameworks of health inequities in end-of-life care and health outcomes published as of February 2022. Implications for nursing:There is a strong need for research that can address multiple factors influencing end-of-life care inequities and health outcomes. To mitigate the complex nature of social determinants of health and structural inequities, researchers, clinicians, educators and administrators should have solid conceptualizations of these multi-level factors. Based on sound and comprehensive frameworks, nurses with interdisciplinary partnerships can promote health equity with a broader health care scope through addressing social determinants of health. Conclusion:We identified and reviewed three frameworks. We concluded all three frameworks have the potential for use in the examination of health inequities in endof-life care and health outcomes. However, the Conceptual Framework of Minority Access to End-of-Life Care was more applicable to diverse studies and settings when adapted to include fundamental characteristics such as sex and gender.Impact: Despite the substantial rise in end-of-life care delivery, health inequities persist in end-of-life care access and utilization. Though some studies have been conducted to promote health equity by addressing social determinants of health, progress is hampered by their complex and multi-faceted nature. Through a concrete conceptual framework, researchers can comprehensively examine multi-level factors influencing health inequities in end-of-life care.No patient or public contribution: This discussion paper focused on reviewing existing evidence.

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Rural disparities in end‐of‐life care for patients with heart failure: Are they due to geography or socioeconomic disparity?

Cited by 7 publications

References 44 publications

Association of Rurality With Risk of Heart Failure

Association of Rurality With Risk of Heart Failure

Awareness of Hospice Care Among Rural African-Americans: Findings From Social Determinants of Health Framework

A comparison of conceptual frameworks to examine health inequities in End‐of‐Life care

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