Geographic Disparities in Heart Failure Hospitalization Rates Among Medicare Beneficiaries

Objectives This study was designed to document local-level geographic disparities in heart failure (HF) hospitalization rates among Medicare beneficiaries. Background Although the burden of HF is well documented at the national level, little is known about the geographic disparities in HF. Methods The study population consisted of fee-for-service Medicare beneficiaries >= 65 years of age who resided in the U.S., Puerto Rico, or the U.S. Virgin Islands during the years 2000 to 2006. Using hospital claims data for Medicare beneficiaries, we calculated spatially smoothed and age-adjusted average annual county-level HF hospitalization rates per 1,000 Medicare beneficiaries for the total population and by racial/ethnic group (blacks, Hispanics, and whites) for the years 2000 to 2006. A HF hospitalization was defined as a short-stay hospital claim with a principal (first-listed) discharge diagnosis of HF using the International Classification of Diseases-9th Revision-Clinical Modification code 428. Results The average annual age-adjusted HF hospitalization rate per 1,000 Medicare beneficiaries was 21.5 per 1,000, and ranged from 7 to 61 per 1,000 among counties in the U.S. For the total study population, a clear East-West gradient was evident, with the highest rates located primarily along the lower Mississippi River Valley and the Ohio River Valley, including the Appalachian region. Similar patterns were observed for blacks and whites, although the pattern for Hispanics differed. Conclusions The evidence of substantial geographic disparities in HF hospitalizations among Medicare beneficiaries is important information for health professionals to incorporate as they design prevention and treatment policies and programs tailored to the needs of their communities. (J Am Coll Cardiol 2010; 55: 294-9) (C) 2010 by the American College of Cardiology Foundation