Racial and Ethnic Differences in 30-Day Hospital Readmissions Among US Adults With Diabetes

Rodríguez-Gutiérrez, René; Herrin, Jeph; Lipska, Kasia J.; Montori, Víctor M.; Shah, Nilay D.; McCoy, Rozalina G.

doi:10.1001/jamanetworkopen.2019.13249

Cited by 47 publications

(33 citation statements)

References 37 publications

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“…African American race patients were also found to have a higher LOS. These results are consistent with findings from other studies [ 13 - 15 ]. This may reflect differences in access to care and socioeconomic status and points to a higher risk population for which additional safeguards should be considered to maintain a safe discharge.…”

Section: Discussionsupporting

confidence: 94%

Impact of Length of Stay on Readmission in Hospitalized Patients

Rachoin¹,

Aplin²,

Gandhi³

et al. 2020

Cureus

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Background Readmission and length of stay (LOS) are two hospital-level metrics commonly used to assess the performance of hospitalist groups. Healthcare systems implement strategies aimed at reducing both. It is possible that tactics aimed at improving one measure in individual patients may adversely impact the other. Objective We sought to analyze the impact of length of stay on readmission risk in an inpatient general medical population to assess whether patients with a lower length of stays were readmitted more frequently to the hospital. Methods We performed a retrospective analysis of inpatient adult patients admitted to our institution between January 2016 and December 2019. We recorded demographic variables and the outcomes of LOS and 30-day readmission. We excluded patients who expired, left against medical advice, or were transferred to other hospitals. We performed both univariate and multivariate analyses. Results There were 91,723 patients included in the study of which 10,598 (11.6%) were readmitted. The geometric LOS for all patients was 5.37 days and was higher in readmitted patients (6.87 vs 5.18 days, respectively, p < 0.001). Patients with higher readmission rates were older, had a higher proportion of male gender, African-American ethnicity, and were more likely to have Medicare or Medicaid payors. After performing a multivariate regression analysis, we found that a high LOS was associated with a higher likelihood of readmission (P < 0.001). Conclusion Contrary to our initial hypothesis, we found that general medical patients with a higher LOS had a higher likelihood of being readmitted to the hospital after adjusting for other variables. It is possible that factors not captured in the current dataset may help explain both the increase in LOS and readmission risk.

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Section: Discussionsupporting

confidence: 94%

Impact of Length of Stay on Readmission in Hospitalized Patients

Rachoin¹,

Aplin²,

Gandhi³

et al. 2020

Cureus

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“…This contrasted with white men who had a higher proportion of hospitalizations compared to white women. Our findings are in concert to a recent evaluation of rehospitalization [ 20 ]. Black patients had a higher risk of readmission compared with white patients (OR, 1.15; 95% CI, 1.12–1.18; P < 0.001), An administrative claims data set of commercially insured and Medicare Advantage beneficiaries across the United States was used.…”

Section: Discussionsupporting

confidence: 88%

Racial disparity in atherosclerotic cardiovascular disease in hospitalized patients with diabetes 2005–2015: Potential warning signs for future U.S. public health

Sidhu

Ward

Ferdinand

2020

American Journal of Preventive Cardiology

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Introduction The pattern of atherosclerotic cardiovascular disease (ASCVD) and diabetes driven hospitalizations in the United States (U.S.) is unclear. We attempted to identify the disparate outcome in race related ASCVD hospitalizations with comorbid diabetes. Methods Adults aged ≥40 years old with ASCVD (acute coronary syndrome (ACS), coronary artery disease (CAD), stroke, or peripheral arterial disease (PAD)) as the first-listed diagnosis with comorbid diabetes as a secondary diagnosis were determined using the U.S. 2005–2015 National (Nationwide) Inpatient Sample (NIS) data. The incidence of other modifiable cardiovascular risk factors (hypertension, dyslipidemia, smoking/substance abuse, obesity, and renal failure), in hospital procedures and outcomes was estimated. Complex samples multivariate regression was used to determine the odds ratio (OR) with 95% confidence Interval (CI) of risk associations and to determine patient comorbidity adjusted ASCVD related in-hospital mortality rate. Results The rate of total ASCVD hospitalizations with comorbid diabetes adjusted to the U.S. census population increased by 5.7% for black men compared to 4% for black women. There was a higher odd of an ASCVD hospitalization if there was comorbid hypertension (Odds Ratio (OR 1.29; 95% CI 95% 1.28–1.31), dyslipidemia (OR 2.03; 95% CI 2.01–2.05), renal failure (OR 1.84; 95% CI 1.82–1.86), and smoking/substance use disorder (OR 1.31; 95% CI 1.29–1.33). White Women had the highest risk-adjusted incidence of ASCVD related in-hospital mortality (4.2%) relative to black women (3.9%), compared to white men (3.6%) and black men (3.5%) respectively. Conclusions Despite improving treatment options for ASCVD in the diabetic population, blacks with diabetes continue to have a higher hospitalization burden with a concomitant disparity in comorbid presentation and outcome. Further evaluation is the need to understand these associations.

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“…Race and racism are a public health issue. We already knew this through numerous studies that have found Black Americans have worse outcomes in conditions as broad as diabetes, 11 hypertension, 12 pregnancy‐related mortality, 13 injury from legal interventions, 14 and even oral health 4 . In 2020, the American Medical Association enacted a policy that acknowledges racism is a public health issue 15 .…”

Section: Introductionmentioning

confidence: 99%

Diversity, equity, and inclusion interventions to support admissions have had little benefit to Black students over past 20 years

Nalliah

Timothé

Reddy

2021

Journal of Dental Education

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The United States has a history of systemic racism and violence toward minority communities. Unfortunately, the last year has demonstrated that systemic racism, and its consequences, persist. The dental profession has also failed to adequately resolve known issues of racial inequity and systemic racism, with persistent disparities in oral health outcomes for Black Americans compared to all other Americans, underrepresentation of minorities in the profession, and barriers to entry. However, dental education has the opportunity to address these issues. Current accreditation standards do not specifically address racial diversity among the student body, yet it is clear that representation of a population matters and the lack of representation may exacerbate race and racism as public health issues in dentistry. To explore the issue, we curated American Dental Education Association (ADEA) data on the race of students admitted and enrolled into dental programs across the United States. We used data visualization techniques to present the data and study trends. While the number of Black and African American (BAA) enrollees in dental schools has increased between 2000 and 2019, this population continues to make up a disproportionately small percentage of all enrollees, relative to the BAA percentage in the U.S. population. Much of the increase in BAA enrollment is attributable to increased places (due to the opening of new schools and increased class size in established schools) and the rate of acceptance of BAA students has had limited improvement. Very little progress has been accomplished in growing the enrollment of BAA applicants to dental school in 20 years. As a profession, we also fail to grow interest among our graduates in careers that may support historically underrepresented and marginalized racial groups—public health, rural practice, population research, academia, and health policy. This may be a contributing factor to the oral health disparities faced by Black Americans and have implications for dental education.

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Racial and Ethnic Differences in 30-Day Hospital Readmissions Among US Adults With Diabetes

Cited by 47 publications

References 37 publications

Impact of Length of Stay on Readmission in Hospitalized Patients

Impact of Length of Stay on Readmission in Hospitalized Patients

Racial disparity in atherosclerotic cardiovascular disease in hospitalized patients with diabetes 2005–2015: Potential warning signs for future U.S. public health

Diversity, equity, and inclusion interventions to support admissions have had little benefit to Black students over past 20 years

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