Online Program

Preventable hospitalizations for congestive heart failure in Native Hawaiian, Filipino, and Japanese adults compared to whites

Sunday, November 3, 2013

Tetine Sentell, PhD, Office of Public Health Studies, University of Hawaii at Manoa, Honolulu, HI
Deborah Juarez, ScD, Daniel K. Inouye College of Pharmacy, University of Hawaii, Honolulu, HI
Hyeong Jun Ahn, PhD, Biostatistics Core, University of Hawaii John A. Burns School of Medicine, Honolulu, HI
Jill Miyamura, PhD, Hawaii Health Information Corporation, Honolulu, HI
Todd Seto, University of Hawaii, John A Burns School of Medicine, Honolulu, HI
John J. Chen, PhD, Biostatistics Core, University of Hawaii, John A. Burns School of Medicine, Honolulu, HI
Research Objective: Hospitalizations for congestive heart failure (CHF) are considered to be generally avoidable with good outpatient management and are the most common type of preventable hospitalization as defined by the Agency for Healthcare Research and Quality (AHRQ). Little is known about preventable hospitalizations for CHF among Asian and Pacific Islanders, though many of these populations have high rates of heart disease.

Study Design: We used Hawaii Health Information Corporation data, which provides detailed discharge data from all hospitalizations in Hawaii, from December 2006-December 2010 for individuals aged 18+ who were Japanese, Native Hawaiian, Filipino, or White and who lived in Hawaii. Preventable hospitalizations for CHF were defined by AHRQ criteria. CHF preventable hospitalizations were compared in rates and rate ratios (RR [95% CI]) for Asian and Pacific Islander groups compared to Whites using population totals by race/ethnicity as denominators. Final multivariable negative binomial models adjusted for age, gender, co-morbidity, and insurer.

Population Studied: The total number of hospitalizations was 258,244 excluding transfers.

Principal Findings: The total number of CHF preventable hospitalizations was 9,824, or 3.8% of total hospitalizations. In unadjusted analyses, rates of CHF preventable hospitalizations were higher for Filipinos (RR: 1.39 [1.32-1.48]) and Native Hawaiians (RR: 1.14 [1.08-1.20]) compared to Whites, but were slightly lower for Japanese (RR: 0.93 [0.88-0.99]). In fully adjusted models, Native Hawaiians continued to have significantly higher rates of CHF preventable hospitalizations compared to Whites (adjusted RR: 1.90 [1.30, 2.77]). Significance was not seen for Filipino and Japanese CHF preventable hospitalization rates compared to Whites. Also of note, Native Hawaiians with preventable hospitalizations for CHF had the youngest average age (62.7 years), followed Filipinos (67.8), Whites (71.7), and Japanese (75.7) (p<0.0001).

Conclusions: This study identified almost 10,000 hospital visits in a four-year period in Hawaii that could have potentially been avoided with better primary care for heart disease. This study finds failures in the management of heart disease (i.e. potentially avoidable CHF hospitalizations) exists for some Asian and Pacific Islander subgroups, particularly Native Hawaiians. Native Hawaiians also had younger ages of hospitalizations for this condition.

Learning Areas:

Administer health education strategies, interventions and programs
Diversity and culture
Provision of health care to the public
Public health or related research

Learning Objectives:
Compare rates of preventable hospitalizations for Congestive Heart Failure in Native Hawaiian, Filipino, and Japanese Adults compared to Whites.

Keyword(s): Heart Disease, Asian and Pacific Islander

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have worked with this data for several years and am the PI of a federally funded grant on this topic.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.