Wan Thomas T H, Lin Yi-Ling, Ortiz Judith
College of Health and Public Affairs, University of Central Florida, Orlando, FL, USA.
Health Serv Res Manag Epidemiol. 2016 Oct 7;3:2333392816671638. doi: 10.1177/2333392816671638. eCollection 2016 Jan-Dec.
This study examined racial variability in diabetes hospitalizations attributable to contextual, organizational, and ecological factors controlling for patient variabilities treated at rural health clinics (RHCs). The pooled cross-sectional data for 2007 through 2013 for RHCs were aggregated from Medicare claim files of patients served by RHCs. Descriptive statistics were presented to illustrate the general characteristics of the RHCs in 8 southeastern states. Regression of the dependent variable on selected predictors was conducted using a generalized estimating equation method. The risk-adjusted diabetes mellitus (DM) hospitalization rates slightly declined in 7 years from 3.55% to 2.40%. The gap between the crude and adjusted rates became wider in the African American patient group but not in the non-Hispanic white patient group. The average DM disparity ratio increased 17.7% from the pre-Affordable Care Act (ACA; 1.47) to the post-ACA period (1.73) for the African American patient group. The results showed that DM disparity ratios did not vary significantly by contextual, organizational, and individual factors for African Americans. Non-Hispanic white patients residing in large and small rural areas had higher DM disparity ratios than other rural areas. The results of this study confirm racial disparities in DM hospitalizations. Future research is needed to identify the underlying reasons for such racial disparities to guide the formulation of effective and efficient changes in DM care management practices coupled with the emphasis of culturally competent, primary and preventive care.
本研究调查了农村健康诊所（RHC）治疗的患者在控制患者变异性的情况下，因背景、组织和生态因素导致的糖尿病住院治疗中的种族差异。2007年至2013年RHC的汇总横断面数据来自RHC服务患者的医疗保险理赔档案。呈现描述性统计数据以说明东南部8个州RHC的一般特征。使用广义估计方程方法对选定预测变量进行因变量回归。经过风险调整的糖尿病（DM）住院率在7年中从3.55%略有下降至2.40%。非裔美国患者组中粗率和调整率之间的差距变得更大，但非西班牙裔白人患者组并非如此。对于非裔美国患者组，平均DM差异比从《平价医疗法案》（ACA）之前的时期（1.47）到ACA之后的时期（1.73）增加了17.7%。结果表明，非裔美国人的DM差异比在背景、组织和个体因素方面没有显著差异。居住在大、小农村地区的非西班牙裔白人患者的DM差异比高于其他农村地区。本研究结果证实了DM住院治疗中的种族差异。需要未来的研究来确定这种种族差异的潜在原因，以指导制定有效且高效的DM护理管理实践变革，并强调具有文化能力的初级和预防护理。
