Racial/Ethnic Disparities in Hospital Readmissions for DiabetesRelated Complications

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Slide 1 : Racial/Ethnic Disparities in Hospital Readmissions for Diabetes-Related Complications H. Joanna Jiang, PhD, Roxanne Andrews, PhD, Daniel Stryer, MD, Bernard Friedman, PhD March 25, 2006
Slide 2 : Background Diabetes Fact Sheet Affects about 20.8 million Americans, or 7% of the population (CDC 2005) The 6th leading cause of death in the U.S. (CDC 2005) Total direct medical costs = $92 billion, of which 44% spent on inpatient care (ADA 2003) Diabetes disproportionately affects racial/ethnic minority populations 1.7 to 2.2 times more common among American Indians and Alaska Natives, non-Hispanic Blacks, Hispanic/Latino Americans, and Asian Americans and Pacific Islanders Higher death rates for American Indians, Blacks, and Hispanics .
Slide :
Slide 4 : Background (cont.) –Findings of Prior Research Blacks and Hispanics were Less likely to self-monitor blood glucose level More likely to have poor glycemic control (Harris 1999; 2001) Poor glycemic control is the most significant predictor for hospitalization among people with diabetes (Moss 1999) Higher hospitalization rates for diabetes among Blacks and Hispanics (Davis 2003, OSHPD 2003, NHDR 2003) .
Slide 5 : Research Question Are racial/ethnic minorities at higher risk for hospital readmission for diabetes-related conditions? Motivation for studying readmission After one hospital stay, subsequent admissions may indicate poorly controlled progression of the condition, in part due to inadequate secondary and tertiary prevention Increasing attention to better manage the condition against further deterioration would be expected Effective follow-up care can help prevent some of the readmissions and associated medical expenditures .
Slide 6 : Methods Data Source: Healthcare Cost Utilization Project (HCUP) HCUP is a federal-state-industry partnership sponsored by AHRQ Contains all discharge abstracts from virtually all community hospitals (incl. academic medical centers) in participating states Study subjects Non-maternal adult patients (age 18+) In 5 states (CA, MO, NY, TN, VA) Had at least 1 admission for diabetes-related conditions during the first 6 months of 1999 Diabetes-related conditions identified by principal and secondary diagnoses .
Slide 7 : Methods (cont.) Identify readmissions using encrypted person number Encrypted person numbers with inconsistent age (different by > 1 yr) or sex range from 0.6% to 1.9% across states Readmissions for diabetes-related conditions only Within 180 days after discharge of the index admission Estimate racial/ethnic differences in the likelihood of readmission by payer group, controlling for Demographic characteristics (e.g., age, gender) Clinical characteristics of the index hospital stay (e.g., diabetes complications, comorbidities, ER admission, major surgery, length of stay, disposition, admission month) Income at patient zipcode, rural/urban location Hospital attributes (e.g., size, ownership, teaching status) .
Slide 8 : Final Sample Size .
Slide 9 : 180-Day Readmissions Observed rate Risk-adjusted odds ratio Private, age 18-64 White 21.4 1.00 Black 20.2 1.01 (0.93-1.09) Hispanic 23.1* 1.12 (1.03-1.23)* Medicaid, age 18-64 White 32.5 1.00 Black 33.0 1.08 (1.00-1.17) Hispanic 34.2* 1.14 (1.05-1.24)** Medicare, age 65+ White 27.9 1.00 Black 30.7** 1.12 (1.07-1.18)** Hispanic 34.0** 1.29 (1.23-1.36)** *P<.05, **P<.01 .
Slide 10 : Risk-Adjusted Odds Ratios of 180-Day Readmission: by Race/Ethnicity and Income White Black Hispanic Private, age 18-64 High income 1.00 0.89 (0.75-1.04) 1.00 (0.82-1.21) Medium-low income 1.02 (0.95-1.09) 1.05 (0.96-1.16) 1.19 (1.06-1.32)** Medicaid, age 18-64 High-medium income 1.00 1.14 (1.03-1.26)** 1.16 (1.05-1.29)** Low income 1.14 (1.03-1.26)* 1.14 (1.03-1.25)* 1.24 (1.12-1.38)** Medicare, age 65+ High-medium income 1.00 1.13 (1.06-1.20)** 1.29 (1.21-1.37)** Low income 1.08 (1.03-1.13)** 1.22 (1.15-1.31)** 1.44 (1.33-1.56)** *P<.05, **P<.01(Note: Household income categories were defined by quartiles specific to each state.) .
Slide 11 : Reasons for Readmission by Race/Ethnicity, among Medicare Patients .
Slide 12 : Reasons for Readmission by Race/Ethnicity, among Medicare Patients (cont.) .
Slide 13 : Conclusions Racial/ethnic disparities are evident in hospital readmissions for diabetes-related conditions, and strongest among the Medicare population Within each payer, Hispanics from low income communities had the highest risk of readmission Readmission diagnoses also vary by race/ethnicity Higher % of acute and microvascular complications for Blacks and Hispanics Higher % of macrovascular complications for nonHispanic Whites .
Slide 14 : Full article published in AJPHJiang HJ, Andrews R, Stryer D, Friedman B. 2005. “Racial/ethnic disparities in potentially preventable readmissions: The case of diabetes.” American Journal of Public Health 95 (9): 1561-1567 Contact information:joanna.jiang@ahrq.gov, or 301-427-1436 at AHRQ Thanks!

 


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