Impact of race on health care utilization and outcomes in veterans with congestive heart failure

Anita Deswal, Nancy J. Petersen, Julianne Souchek, Carol M. Ashton, Nelda Wray

Research output: Contribution to journalArticlepeer-review

103 Scopus citations


Objectives The objectives of this study were to determine racial differences in mortality in a national cohort of patients hospitalized with congestive heart failure (CHF) within a financially "equal-access" healthcare system, the Veterans Health Administration (VA), and to examine racial differences in patterns of healthcare utilization following hospitalization. Background To explain the observed paradox of increased readmissions and lower mortality in black patients hospitalized with CHF, it has been postulated that black patients may have reduced access to outpatient care, resulting in a higher number of hospital admissions for lesser disease severity. Methods In a retrospective study of 4,901 black and 17,093 white veterans hospitalized with CHF in 153 VA hospitals, we evaluated mortality at 30 days and 2 years, and healthcare utilization in the year following discharge. Results The risk-adjusted odds ratios (OR) for 30-day and 2-year mortality in black versus white patients were 0.70 (95% confidence interval [CI] 0.60 to 0.82) and 0.84 (95% CI 0.78 to 0.91), respectively. In the year following discharge, blacks had the same rate of readmissions as whites. Blacks had a lower rate of medical outpatient clinic visits and a higher rate of urgent care/emergency room visits than whites, although these differences were small. Conclusions In a system where there is equal access to healthcare, the racial gap in patterns of healthcare utilization is small. The observation of better survival in black patients after a CHF hospitalization is not readily explained by differences in healthcare utilization.

Original languageEnglish (US)
Pages (from-to)778-784
Number of pages7
JournalJournal of the American College of Cardiology
Issue number5
StatePublished - Mar 3 2004


  • CHF
  • Congestive heart failure
  • Diagnosis related group
  • DRG
  • Emergency room
  • ER
  • Heart failure
  • HF
  • ICD-9-CM
  • International Classification of Diseases-Ninth Revision-Clinical Modification
  • Patient treatment files
  • PTF
  • VA
  • Veterans Health Administration

ASJC Scopus subject areas

  • Nursing(all)


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