Frankel Dianne, Banaag Amanda, Madsen Cathaleen, Koehlmoos Tracey
Uniformed Services University of the Health Sciences; 4301 Jones Bridge Road, Bethesda, MD, 20814.
Henry M. Jackson Foundation for the Advancement of Military Medicine, 6720A Rockledge Drive, Bethesda, MD, 20817.
Mil Med. 2020 Sep 18;185(9-10):e1679-e1685. doi: 10.1093/milmed/usaa153.
Diabetes is one of the most common chronic conditions in the United States and has a cost burden over $120 billion per year. Readmissions following hospitalization for diabetes are common, particularly in minority patients, who experience greater rates of complications and lower quality healthcare compared to white patients. This study examines disparities in diabetes-related readmissions in the Military Health System, a universally insured, population of 9.5 million beneficiaries, who may receive care from military (direct care) or civilian (purchased care) facilities.
The study identified a population of 7,605 adult diabetic patients admitted to the hospital in 2014. Diagnostic codes were used to identify hospital readmissions, and logistic regression was used to analyze associations among race, beneficiary status, patient or sponsor's rank, and readmissions at 30, 60, and 90 days.
A total of 239 direct care patients and 545 purchased care patients were included in our analyses. After adjusting for age and sex, we found no significant difference in readmission rates for black versus white patients; however, we found a statistically significant increase in the likelihood for readmission of Native American/Alaskan Native patients compared to white patients, which persisted in direct care at 60 days (adjusted odds ratio [AOR] 11.51, 95% CI 1.11-119.41) and 90 days (AOR 18.42, 95% CI 1.78-190.73), and in purchased care at 90 days (AOR 4.54, 95% CI 1.31-15.74).
Our findings suggest that universal access to healthcare alleviates disparities for black patients, while Native America/Alaskan Native populations may still be at risk of disparities associated with readmissions among diabetic patients in both the closed direct care system and the civilian fee for service purchased care system.
糖尿病是美国最常见的慢性病之一，每年的成本负担超过1200亿美元。糖尿病住院后的再入院情况很常见，尤其是在少数族裔患者中，与白人患者相比，他们经历并发症的几率更高，医疗质量更低。本研究调查了军事医疗系统中与糖尿病相关的再入院差异，该系统为950万受益人提供全民保险，这些受益人可在军事（直接护理）或民用（购买护理）设施接受治疗。
该研究确定了2014年入院的7605名成年糖尿病患者群体。使用诊断编码来识别医院再入院情况，并使用逻辑回归分析种族、受益状况、患者或担保人的军衔以及30天、60天和90天再入院之间的关联。
我们的分析共纳入了239名直接护理患者和545名购买护理患者。在调整年龄和性别后，我们发现黑人和白人患者的再入院率没有显著差异；然而，我们发现，与白人患者相比，美国原住民/阿拉斯加原住民患者再入院的可能性在统计学上显著增加，这种情况在直接护理的60天（调整优势比[AOR]为11.51，95%置信区间为1.11-119.41）和90天（AOR为18.42，95%置信区间为1.78-190.73）以及购买护理的90天（AOR为4.54，95%置信区间为1.31-15.74）时仍然存在。
我们的研究结果表明，全民医疗保健可减轻黑人患者的差异，而美国原住民/阿拉斯加原住民群体在封闭的直接护理系统和民用服务收费购买护理系统中，可能仍然面临与糖尿病患者再入院相关的差异风险。
