Racial Differences in Hospital Discharge Disposition among Stroke Patients in Maryland

Onukwugha, E.; Mullins, C. Daniel

doi:10.1177/0272989x07302130

Cited by 13 publications

(12 citation statements)

References 42 publications

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“…However, this study adjusted for fewer covariates than our study, and also used a broader definition of stroke that included ICD-9-CM codes with low positive predictive values for current strokes (i.e. 433, 437 and 438) [12] .…”

Section: Discussionmentioning

confidence: 99%

Recent Racial/Ethnic Disparities in Stroke Hospitalizations and Outcomes for Young Adults in Florida, 2001–2006

Pathak¹,

Sloan

2009

Neuroepidemiology

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Background: Black-white disparities in stroke mortality are well documented, but few recent studies have examined racial/ethnic disparities in stroke hospitalizations among young adults. We analyzed recent (2001–2006) trends in stroke hospitalizations and hospital case-fatality for black, Hispanic, and white adults aged 25–49 years in Florida. Methods: Hospitalization rates were calculated using population estimates from the census, and hospital discharges with a primary diagnosis of stroke (ICD-9-CM 430, 431, 434, 436) (n = 16,317). Multivariate logistic regression modeling was used to examine racial/ethnic disparities in stroke mortality prior to discharge, after adjustment for patient sociodemographics, stroke subtype, risk factors, and comorbidities. Results: Age-adjusted stroke hospitalization rates for blacks were over 3 times higher than rates for whites, while rates for Hispanics were slightly higher than rates for whites. Hemorrhagic strokes were proportionally greater among Hispanics compared with blacks and whites (p < 0.0001). Blacks were most likely to have diagnosed hypertension (62.3%), morbid obesity (10.9%) or drug abuse (13.6%). Whites were most likely to have diagnosed hyperlipidemia (21.0%), alcohol abuse (9.5%), and to be smokers (30.6%). The in-hospital fatality rate for all strokes was highest among blacks (10.0%) compared with whites (9.0%) and Hispanics (8.2%). After adjustment for age, gender, insurance status, and all diagnosed risk factors and comorbidities, the black excess was no longer observed [odds ratio (OR) 1.01, 95% confidence interval (CI) 0.88–1.15, p = 0.93]. However, the Hispanic advantage in case-fatality was strengthened (OR 0.66, 95% CI 0.55–0.79, p < 0.0001). Separate case-fatality analyses for ischemic versus hemorrhagic strokes yielded similar results. Conclusions: Our study found a strong and persistent black-white disparity in stroke hospitalization rates for young adults. In contrast, rates were similar for Hispanics and whites. Multivariate adjustment explained the 15% excess case-fatality for blacks; the short-term mortality advantage among Hispanics was strengthened after adjustment.

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Section: Discussionmentioning

confidence: 99%

Recent Racial/Ethnic Disparities in Stroke Hospitalizations and Outcomes for Young Adults in Florida, 2001–2006

Pathak¹,

Sloan

2009

Neuroepidemiology

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“…21 According to a sample of more than 50,000 stroke victims, black patients were found to experience far worse outcomes than white patients in terms of disposition at discharge to nonresidential setting and a higher incidence of mortality. 22 Black men were more likely to be discharged to a medical care facility rather than to home, and black women were at highest risk for either intrahospital death or discharge to a setting other than home.…”

Section: Discussionmentioning

confidence: 95%

“…9 The racial disparities in access to health care, processes of care, and outcomes from that care have, in general, been consistently reported. [19][20][21][22][23] Racial disparities in 180-day hospital readmission rates among adult patients with diabetes-related conditions have been identified in Hispanic patients, regardless of health insurance status, and in non-Hispanic black Medicare enrollees. 19 Non-white patients had significantly worse outcomes, including increased risk of death, acute myocardial infarction, and rehospitalization for acute coronary syndrome in a randomized trial of invasive versus conservative treatment strategy (TACTICS-TIMI).…”

Section: Discussionmentioning

confidence: 99%

Does race affect readmission to hospital after critical illness?

et al. 2009

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Section: Introductionmentioning

confidence: 99%

“…A significant number of stroke victims are treated in a hospital setting and of these, the majority are discharged alive [29]. Studies of live discharges following stroke have focused largely on discharges to follow-up care or to the home [29]. Overlooking discharges against medical advice in stroke patients may be costly given research findings in other settings showing that discharges AMA are correlated with adverse health outcomes and higher costs [2,3,8,12,15,16,21,23,32,36].…”

Section: Introductionmentioning

confidence: 99%

The dual impact of rehabilitation admission and race/ethnicity on discharges against medical advice

Onukwugha

Weir

2009

NRE

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Introduction: Predictors of hospital discharges against medical advice (AMA), including race/ethnicity, have been examined previously. However, the predictive effect of an admission for rehabilitative care has not been examined in an inpatient stroke population, nor has the impact of race/ethnicity on this relationship been reported. Methods: Live hospital discharges with a primary diagnosis of stroke from 2000-2005 were identified in a longitudinal dataset. The outcome of interest was a discharge AMA. A hierarchical logistic model was estimated to examine the effect of race/ethnicity and rehabilitative care on the outcome while controlling for patient and hospital characteristics. Results: A total of 569 of the 79,561 stroke admissions (0.7%) ended in a discharge AMA. There were 1,565 admissions for rehabilitative care and 32% of patients were non-Caucasian. Among Caucasians, adjusted odds of a discharge AMA were higher for patients with an admission for rehabilitative care (AOR = 3.83, p < 0.0001). Among those not admitted for rehabilitative care, non-Caucasian patients were more likely to leave AMA (AOR = 1.4; p = 0.0005).Conclusions: This study identifies dependence between race/ethnicity, rehabilitative care, and discharges AMA. More research is needed to understand the implications of differential rates of discharges AMA among race/ethnic groups and across patient care settings.

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Racial Differences in Hospital Discharge Disposition among Stroke Patients in Maryland

Abstract: Blacks are at greater mortality risk following stroke hospitalizations and face less desirable discharge dispositions if they survive. These results are consistent with prior reports of lower survival rates among blacks and are robust to adjustments for various confounding factors.

Cited by 13 publications

References 42 publications

Recent Racial/Ethnic Disparities in Stroke Hospitalizations and Outcomes for Young Adults in Florida, 2001–2006

Recent Racial/Ethnic Disparities in Stroke Hospitalizations and Outcomes for Young Adults in Florida, 2001–2006

Does race affect readmission to hospital after critical illness?

The dual impact of rehabilitation admission and race/ethnicity on discharges against medical advice

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