Jiang H Joanna, Andrews Roxanne, Stryer Daniel, Friedman Bernard
Center for Delivery, Organization and Markets, Agency for Healthcare Research and Quality, 540 Gaither Rd, Rockville, MD 20850, USA.
Am J Public Health. 2005 Sep;95(9):1561-7. 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.
不同种族/族裔群体在糖尿病患病率和疾病管理方面存在显著差异。我们研究了种族/族裔与糖尿病相关疾病住院再入院之间的关系。
从医疗成本和利用项目1999年的州住院数据库中识别出5个州因糖尿病相关疾病住院的非孕产妇成年患者，这些患者拥有医疗保险、医疗补助或私人保险。通过逻辑回归估计再入院可能性的种族/族裔差异，并对患者的人口统计学、临床和社会经济特征以及医院属性进行调整。
在所有3种支付方中，非西班牙裔白人180天再入院的风险调整可能性显著低于西班牙裔；在医疗保险参保者中，非西班牙裔黑人的该可能性也显著低于西班牙裔。在每种支付方中，来自低收入社区的西班牙裔再入院风险最高。在医疗保险受益人中，黑人和西班牙裔因急性并发症和微血管疾病再入院的比例较高，而白人因大血管疾病再入院的比例较高。
种族/族裔差异在180天再入院率中比在30天再入院率中更明显，且在医疗保险人群中最为显著。再入院诊断因种族/族裔而异，黑人和西班牙裔发生那些通过有效的出院后护理更有可能预防的并发症的风险较高。
