Description:
Introduction: Socioeconomic disparities in cardiovascular and renal disease pose global public health challenges Despite its large population, Asia lacks proportional representation in heart failure (HF) data, limiting our understanding of risk factors and outcomes for Asians with HF and severe CKD. This study aims to explore the sex, racial, and ethnic differences in in-hospital all-cause mortality, baseline risk factors, and in-hospital complications among Asian patients admitted for HF with CKD. Hypothesis: Asian patients with CKD admitted for HF are linked with increased mortality, in-hospital complications, higher costs, and a longer length of stay compared to non-Asian patients. Methods: This retrospective study included patients 18 or older with heart failure and CKD 3-5 on discharge from 2016 to 2019. Multivariate logistic regression calculated the odds ratio (OR) adjusting for Elixhauser co-morbidities, age, and sex. The primary outcome was disparities in racial/ethnic, sex, and age of in-hospital mortality of patients admitted for HF complicated by CKD. Results: This study involved 510,525 patients, revealing Hispanics (OR: 0.791; CI: 07125-0.8747; p<0.001) and African Americans (OR: 0.664; CI: 0.608-0.7258; p<0.001) were associated with significantly lower mortality compared to Asians. Controlling for age and gender, Asians with HF & CKD had significantly higher odds of diabetes, hyperlipidemia, and hypertension compared to non-Asians. Asian males with HF and CKD were associated with significantly higher odds of mortality (OR: 1.072; CI: 1.037-1.109; p<0.001) and cardiovascular co-morbidities including atrial fibrillation, coronary bypass graft, implantable pacemaker, and chronic ischemic heart disease compared to non-Asian males. Asians, compared to non-Asians, were associated with significantly higher odds of acute MI, acute kidney injury, sepsis, and PRBC transfusion when controlling for Elixhauser co-morbidities. Conclusions: This study reveals significant health disparities among Asian patients with HF and CKD. The significant difference in odds of mortality and cardiovascular co-morbidities indicates the need for further research regarding the possible causality of such disparities.