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

• Published in: American journal of public health (1971) 2005-09, Vol.95 (9), p.1561-1567
• Main Authors: Jiang, H. Joanna, Andrews, Roxanne, Stryer, Daniel, Friedman, Bernard
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; African Americans - statistics & numerical data; Aged; Aged, 80 and over; Biological and medical sciences; Cultural differences; Databases as Topic; Diabetes; Diabetes Mellitus - epidemiology; Diabetes Mellitus - ethnology; Diabetes Mellitus - therapy; Diabetes. Impaired glucose tolerance; Disease; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Ethnicity; Etiopathogenesis. Screening. Investigations. Target tissue resistance; European Continental Ancestry Group - statistics & numerical data; Family income; Female; Health care access; Health Care Surveys; Hispanic Americans - statistics & numerical data; Hispanic people; Hospitalization; Hospitals; Hospitals - classification; Hospitals - utilization; Humans; Insurance Claim Review; Low income groups; Male; Medicaid; Medical sciences; Medicare; Middle Aged; Minority & ethnic groups; Miscellaneous; Patient admissions; Patient Readmission - statistics & numerical data; Patients; Postal codes; Public health; Public health. Hygiene; Public health. Hygiene-occupational medicine; Race; Research and Practice; Risk Factors; Rural areas; Social Justice; Socioeconomic Factors; United States - epidemiology
• ISSN: 0090-0036; 1541-0048
• DOI: 10.2105/AJPH.2004.044222

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.