Racial/Ethnic Disparities in Potentially Preventable Readmissions: The Case of Diabetes

Center for Delivery, Organization and Markets, Agency for Healthcare Research and Quality, 540 Gaither Rd, Rockville, MD 20850, USA.
American Journal of Public Health (Impact Factor: 4.55). 10/2005; 95(9):1561-7. DOI: 10.2105/AJPH.2004.044222
Source: PubMed


Considerable differences in prevalence of diabetes and management of the disease exist among racial/ethnic groups. We examined the relationship between race/ethnicity and hospital readmissions for diabetes-related conditions.
Nonmaternal adult patients with Medicare, Medicaid, or private insurance coverage hospitalized for diabetes-related conditions in 5 states were identified from the 1999 State Inpatient Databases of the Healthcare Cost and Utilization Project. Racial/ethnic differences in the likelihood of readmission were estimated by logistic regression with adjustment for patient demographic, clinical, and socioeconomic characteristics and hospital attributes.
The risk-adjusted likelihood of 180-day readmission was significantly lower for non-Hispanic Whites than for Hispanics across all 3 payers or for non-Hispanic Blacks among Medicare enrollees. Within each payer, Hispanics from low-income communities had the highest risk of readmission. Among Medicare beneficiaries, Blacks and Hispanics had higher percentages of readmission for acute complications and microvascular disease, while Whites had higher percentages of readmission for macrovascular conditions.
Racial/ethnic disparities are more evident in 180-day than in 30-day readmission rates, and greatest among the Medicare population. Readmission diagnoses vary by race/ethnicity, with Blacks and Hispanics at higher risk for those complications more likely preventable with effective postdischarge care.

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    • "Furthermore, we defined multiple-hospitalization patients as those who had two or more hospital admissions during a year's time. Whereas previous literature has looked specifically at time between discharge and readmission[5,6], the MEPS data were not complete enough in many cases to measure time between hospitalizations that precisely. "

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    • "However, this study does have limitations which should be considered in the interpretation of results. First, we did not account for racial and ethnic disparities consistently documented to be related to readmission[29,31,39,40]. However, the prevalence of ethnic minorities is so low in the population covered by the Quebec trauma system that these factors were unlikely to have influenced our results[11]. "
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    • "This trend has been seen in many other studies [7,32], likely reflecting the fact that a large percentage of the hospital resources in our country are utilized by a small percentage of patients [10]. In previous studies, demographic factors such as marital status, age and gender have been shown to be predictive of 30-day readmission [21,33,34]. Single marital status was a predictor in the combined model, which may suggest a lack of power to detect a significant finding in the smaller cohorts. "
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