Race and psychiatric diagnostic patterns: understanding the influence of hospital characteristics in the National Hospital Discharge Survey.

Historically, blacks have been more frequently diagnosed with schizophrenia and less frequently diagnosed with mood disorders than whites. Our understanding of why these disparities exist has primarily focused on patient and clinician characteristics and failed to examine the influence of social contextual factors such as hospital characteristics on diagnostic patterns. We analyzed data from the 2007 National Hospital Discharge Survey, a large national database of hospital inpatient stays. The paper examines whether race influences inpatient diagnoses before and after adjustment for select patient and hospital characteristics. Results indicate that blacks were 3-fold more likely to be diagnosed with schizophrenia (odds ratio [OR], 3.68; 95% confidence interval [CI], 2.96-4.57) or a psychotic disorder (OR, 3.39; 95% CI, 2.90-3.96) than whites. However, blacks were less likely than whites to be diagnosed with bipolar disorder (OR, 0.60; 95% CI, 0.50-0.72) or mood disorder (OR, 0.50; 95% CI, 0.43-0.58). These same diagnostic patterns persisted after adjustment for selected patient and hospital characteristics. These results provide confirmation of trends observed in earlier studies of single hospitals with smaller sample sizes. Further research is necessary to determine whether the hospital characteristics selected for these analyses are appropriate proxy measures of factors that influence diagnostic judgment in inpatient settings.