Welcome to PracticeUpdate! We hope you are enjoying temporary access to this content.
Please register today for a free account and gain full access
to all of our expert-selected content.
Already Have An Account? Log in Now
Racial and Ethnic Differences in 30-Day Hospital Readmissions Among Adults With Diabetes
TAKE-HOME MESSAGE
- Adults with diabetes discharged from the hospital were followed to evaluate racial and ethnic differences in all-cause readmission. Black patients, but not Hispanic or Asian patients, had a greater risk of readmission compared with white patients. Both black and Hispanic patients had a high observed-to-expected readmission rate ratio compared with white patients when household income was low and when they were admitted to nonprofit hospitals, academic hospitals, or large hospitals.
- Black patients with diabetes are at greater risk than patients of other ethnicities of readmission following hospital discharge. Further efforts are needed to reduce these persistent racial differences in patient outcomes.
abstract
This abstract is available on the publisher's site.
Access this abstract nowImportance
Differences in readmission rates among racial and ethnic minorities have been reported, but data among people with diabetes are lacking despite the high burden of diabetes and its complications in these populations.
Objectives
To examine racial/ethnic differences in all-cause readmission among US adults with diabetes and categorize patient- and system-level factors associated with these differences.
Design, Setting, and Participants
This retrospective cohort study includes 272 758 adult patients with diabetes, discharged alive from the hospital between January 1, 2009, and December 31, 2014, and stratified by race/ethnicity. An administrative claims data set of commercially insured and Medicare Advantage beneficiaries across the United States was used. Data analysis took place between October 2016 and February 2019.
Main Outcomes and Measures
Unplanned all-cause readmission within 30 days of discharge and individual-, clinical-, economic-, index hospitalization-, and hospital-level risk factors for readmission.
Results
A total of 467 324 index hospitalizations among 272 758 adults with diabetes (mean [SD] age, 67.7 [12.7]; 143 498 [52.6%] women) were examined. The rates of 30-day all-cause readmission were 10.2% (33 683 of 329 264) among white individuals, 12.2% (11 014 of 89 989) among black individuals, 10.9% (4151 of 38 137) among Hispanic individuals, and 9.9% (980 of 9934) among Asian individuals (P < .001). After adjustment for all factors, only black patients had a higher risk of readmission compared with white patients (odds ratio, 1.05; 95% CI, 1.02-1.08). This increased readmission risk among black patients was sequentially attenuated, but not entirely explained, by other demographic factors, comorbidities, income, reason for index hospitalization, or place of hospitalization. Compared with white patients, both black and Hispanic patients had the highest observed-to-expected (OE) readmission rate ratio when their income was low (annual household income <$40 000 among black patients: OE ratio, 1.11; 95% CI, 1.09-1.14; among Hispanic patients: OE ratio, 1.11; 95% CI, 1.07-1.16) and when they were hospitalized in nonprofit hospitals (black patients: OE ratio, 1.10; 95% CI, 1.08-1.12; among Hispanic patients: OE ratio, 1.08; 95% CI, 1.05-1.12), academic hospitals (black patients: OE ratio, 1.16; 95% CI, 1.13-1.20; Hispanic patients: OE ratio, 1.12; 95% CI, 1.06-1.19), or large hospitals (ie, with ≥400 beds; black patients: OE ratio, 1.11; 95% CI, 1.09-1.14; Hispanic patients: OE ratio, 1.09; 95% CI, 1.04-1.14).
Conclusions and Relevance
In this study, black patients with diabetes had a significantly higher risk of readmission than members of other racial/ethnic groups. This increased risk was most pronounced among lower-income patients hospitalized in nonprofit, academic, or large hospitals. These findings reinforce the importance of identifying and addressing the many reasons for persistent racial/ethnic differences in health care quality and outcomes.
Additional Info
Disclosure statements are available on the authors' profiles:
Racial and Ethnic Differences in 30-Day Hospital Readmissions Among US Adults With Diabetes
JAMA Netw Open 2019 Oct 02;2(10)e1913249, R Rodriguez-Gutierrez, J Herrin, KJ Lipska, VM Montori, ND Shah, RG McCoyFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
This large, retrospective cohort study of nearly 273,000 hospitalized adults with diabetes demonstrated that black patients had a significantly higher risk of unplanned all-cause readmission within 30 days of hospital discharge than other racial/ethnic groups. The observed increase in risk was only partially explained by differences in other demographics, comorbidities, reason for hospitalization, and place of hospitalization. Furthermore, the increased risk was most pronounced among patients with lower income and patients in nonprofit, academic, or large hospitals.
The well-done study adds to the conflicting body of evidence examining the association of race/ethnicity with 30-day readmission among diabetes patients. Although some studies have reported increased readmission risk for black and Hispanic patients, others have reported no risk difference and even lower risk relative to white patients.1,2 These differences in observed risk probably relate to differences in the populations studied. An important limitation of the present study acknowledged by the authors is that patients without insurance and those with government-based insurance were not included. Nonetheless, this study provides compelling evidence that black patients suffer worse outcomes than white patients among commercially insured and Medicare Advantage beneficiaries across the US. Further study is urgently needed to narrow the racial/ethnic health disparities among patients with diabetes.
References