Sentell Tetine L, Juarez Deborah T, Ahn Hyeong Jun, Tseng Chien-Wen, Chen John J, Salvail Florentina R, Miyamura Jill, Mau Marjorie K
Office of Public Health Studies, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (TLS).
Hawaii J Med Public Health. 2014 Dec;73(12 Suppl 3):8-13.
Elderly (65+) Native Hawaiian, Filipino, and Japanese men and Filipino women have a higher risk of diabetes-related potentially preventable hospitalizations than Whites even when demographic factors and the higher diabetes prevalence in these populations is considered. The study objective was to determine if similar disparities are seen among the non-elderly (< 65). We used discharge data for all non-maternity hospitalizations by working-age adults (18-64 years) in Hawai'i from December 2006 to December 2010. Annual diabetes-related preventable hospitalization rates (by population diabetes prevalence) were compared by race/ethnicity (Japanese, Chinese, Native Hawaiian, Filipino, and White) and gender. Adjusted rate ratios (aRR) were calculated relative to Whites using multivariable models controlling for insurer, comorbidity, residence location, and age. After adjusting for ethnic-specific prevalence of diabetes and demographic factors, preventable hospitalizations rates were significantly higher for Native Hawaiians males (aRR:1.48; 95%CI:1.08-2.05) compared to Whites, but significantly lower for Chinese men (aRR:0.43;95%CI:0.30-0.61) and women (aRR:0.18;95%CI: 0.08-0.37), Japanese men (aRR:0.33;95%CI: 0.25-0.44) and women (aRR:0.34; 95%CI:0.23-0.51), and Filipino men (aRR:0.35;95%CI:0.28-0.43) and women (aRR:0.47;95%CI: 0.36-0.62). Rates for Native Hawaiian females did not differ significantly from Whites. Disparities in diabetes-related preventable hospitalizations were seen for working-age (18-64) Native Hawaiian men even when their higher population-level diabetes prevalence was considered. Further research is needed to determine factors affecting these disparities and to develop targeted interventions to reduce them. Significantly lower preventable hospitalization rates were seen among Asian groups compared to Whites. A better understanding of these findings may provide guidance for improving rates among Asian elderly as well as other non-elderly groups with disparities.
65岁及以上的夏威夷原住民、菲律宾人和日本男性以及菲律宾女性，即便考虑到人口统计学因素以及这些人群中较高的糖尿病患病率，与白人相比，他们因糖尿病导致的潜在可预防住院风险更高。本研究的目的是确定在非老年人（<65岁）中是否也存在类似的差异。我们使用了2006年12月至2010年12月期间夏威夷州工作年龄成年人（18 - 64岁）所有非产科住院的出院数据。按种族/族裔（日本人、中国人、夏威夷原住民、菲律宾人和白人）和性别比较了年度糖尿病相关可预防住院率（按人群糖尿病患病率）。使用控制了保险公司、合并症、居住地点和年龄的多变量模型，计算相对于白人的调整率比（aRR）。在调整了特定族裔的糖尿病患病率和人口统计学因素后，夏威夷原住民男性的可预防住院率显著高于白人（aRR：1.48；95%CI：1.08 - 2.05），但中国男性（aRR：0.43；95%CI：0.30 - 0.61）和女性（aRR：0.18；95%CI：0.08 - 0.37）、日本男性（aRR：0.33；95%CI：0.25 - 0.44）和女性（aRR：0.34；95%CI：0.23 - 0.51）以及菲律宾男性（aRR：0.35；95%CI：0.28 - 0.43）和女性（aRR：0.47；95%CI：0.36 - 0.62）的可预防住院率则显著低于白人。夏威夷原住民女性的住院率与白人没有显著差异。即便考虑到工作年龄（18 - 64岁）的夏威夷原住民男性较高的总体糖尿病患病率，他们在糖尿病相关可预防住院方面仍存在差异。需要进一步研究以确定影响这些差异的因素，并制定有针对性的干预措施来减少这些差异。与白人相比，亚洲人群的可预防住院率显著较低。更好地理解这些发现可能为提高亚洲老年人以及其他存在差异的非老年人群的住院率提供指导。
