Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, United States.
Biostatistics Center, Kurume University, Kurume, Fukuoka, Japan.
Respir Med. 2017 Oct;131:6-10. doi: 10.1016/j.rmed.2017.07.056. Epub 2017 Jul 25.
Reduction of 30-day readmissions in patients hospitalized for chronic obstructive pulmonary disease (COPD) is a national objective. However, there is a dearth of research on sex and racial/ethnic differences in the reason for 30-day readmission.
We conducted a retrospective cohort study using 2006-2012 data from the State Inpatient Database of eight geographically-diverse US states (Arkansas, California, Florida, Iowa, Nebraska, New York, Utah, and Washington). After identifying all hospitalizations for COPD made by patients aged ≥40 years, we investigated the primary diagnostic code for all-cause readmissions within 30 days after the original COPD hospitalization, among the overall group and by sex and race/ethnicity strata.
Between 2006 and 2012, there was a total of 845,465 COPD hospitalizations at risk for 30-day readmissions in the eight states. COPD was the leading diagnostic for 30-day readmission after COPD hospitalization, both overall (28%) and across all sex and race/ethnicity strata. The proportion of respiratory diseases (COPD, pneumonia, respiratory failure, and asthma) as the readmission diagnosis was higher in non-Hispanic black (55%), compared to non-Hispanic white (52%) and Hispanics (51%) (p < 0.001). The proportion of asthma as the readmission diagnosis differed significantly by sex (6% in men and 9% in women; p < 0.001). Similarly, the proportion of asthma also differed significantly by race/ethnicity (5% in non-Hispanic white, 16% in non-Hispanic black, 15% in Hispanics, 13% in others; p < 0.001).
In this analysis of all-payer population-based data, we found sex and racial/ethnic differences in the reason for 30-day readmission in patients hospitalized for COPD.
降低因慢性阻塞性肺疾病（COPD）住院患者的 30 天再入院率是一个国家目标。然而，对于 30 天再入院的原因在性别和种族/民族差异方面的研究却很少。
我们使用来自美国 8 个地理位置不同的州（阿肯色州、加利福尼亚州、佛罗里达州、爱荷华州、内布拉斯加州、纽约州、犹他州和华盛顿州）的 2006-2012 年国家住院患者数据库进行了回顾性队列研究。在确定所有年龄≥40 岁的 COPD 住院患者后，我们调查了所有 COPD 住院患者在原始 COPD 住院后 30 天内的全因再入院的主要诊断代码，同时按性别和种族/民族分层进行调查。
在 2006 年至 2012 年期间，在这 8 个州共有 845465 例 COPD 住院患者有 30 天再入院的风险。在 COPD 住院后，COPD 是 30 天再入院的主要诊断，无论是整体情况（28%）还是所有性别和种族/民族分层情况都是如此。非西班牙裔黑人（55%）的呼吸系统疾病（COPD、肺炎、呼吸衰竭和哮喘）作为再入院诊断的比例高于非西班牙裔白人（52%）和西班牙裔（51%）（p<0.001）。作为再入院诊断的哮喘比例在男性（6%）和女性（9%）之间有显著差异（p<0.001）。同样，哮喘的比例在种族/民族之间也有显著差异（非西班牙裔白人占 5%，非西班牙裔黑人占 16%，西班牙裔占 15%，其他种族/民族占 13%；p<0.001）。
在这项基于所有支付者的人群数据的分析中，我们发现 COPD 住院患者 30 天再入院的原因存在性别和种族/民族差异。
