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

• Authors: Modele O Ogunniyi, Emory University; James B. Holt, Centers for Disease Control and Prevention; Janet B. Croft, Centers for Disease Control and Prevention; Isaac A. Nwaise, Centers for Disease Control and Prevention; Henry E. Okafor, Meharry Medical College; Douglas B. Sawyer, Vanderbilt University Medical Center; Wayne H. Giles, Centers for Disease Control and Prevention; George A. Mensah, PepsiCo, Inc.
• Journal Title: American Journal of the Medical Sciences
• Volume: Volume 343, Number 1
• Publisher: Lippincott, Williams & Wilkins | 2012-01, Pages 71-77
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1097/MAJ.0b013e318223bbd4
• Subjects: Health Sciences, General; Health Sciences, Health Care Management; Geography
• Keywords: geographic differences; heart failure; elderly; Medicare

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.