Black Patients With Diabetes May Have Greater Hospital Readmission Risk, Study Finds

Black patients with diabetes may have a significantly higher risk of readmission to hospitals than other ethnic and racial minorities due to the high burden and complications of the disease, according to research published in JAMA Network Open.

The study aimed to investigate the racial/ethnic differences in all-cause readmission among patients with diabetes in the United States. The study involved a cohort of 272,758 adult patients with diabetes who had been discharged from the hospital between January 1, 2009 and December 31, 2014. Additionally, the researchers used an administrative claims data set of commercially insured and Medicare Advantage beneficiaries for the analysis.

“Diabetes is among the most prevalent and costly chronic diseases in the United States, costing $327 billion annually and accounting for 1 of every 7 dollars spent on health care in the United States. Diabetes disproportionately affects racial/ethnic minorities, who also have worse diabetes-related health outcomes (ie, microvascular and macrovascular outcomes) and mortality,” explained the authors. “Hospitalizations contribute substantially to the cost and burden of diabetes care, as people with diabetes are more likely to be hospitalized and experience unplanned readmissions than people without diabetes.”

The results revealed that the rates of 30-day all-cause readmission were 10.2% among white individuals, 12.2% among black individuals, 10.9% among Hispanics, and 9.9% among Asian individuals. However, once adjusted for all factors, only black patients had a greater risk of readmission compared with white individuals.

Moreover, the researchers suggested that this significant risk among black patients could not be explained by demographic factors, comorbidities, income, reason for index hospitalization, or place of hospitalization.

When compared with white individuals, black and Hispanic patients had the highest observed-to-expected (OE) readmission rate ratio when their income was low and when they were hospitalized in nonprofit hospitals, academic hospitals, or large hospitals.

“These findings in readmission rates and outcomes are concerning, particularly as they likely underestimate the true impact of racial/ethnic differences in the United States, as our study comprised privately insured individuals with access to care," the authors said, noting that about10% of black residents are uninsured compared with 6% of whites.

The authors emphasized that this research may act as a framework for future studies and suggested that additional factors must be investigated in order to improve the equity and quality of diabetes care.

Reference

Rodriguez-Gutierrez R, Herrin J, Lipska K, et al. Racial and ethnic differences in 30-day hospital readmissions among US adults with diabetes [published online October 11, 2019]. JAMA Network Open. doi:10.1001/jamanetworkopen.2019.13249.