Increased Risk for Hospital Readmissions Among Black Patients With Diabetes

Close-up of a patient’s hand in a hospital bed
Researchers assessed whether rates of unplanned 30-day hospital readmission differed among white, black, Hispanic, and Asian individuals with diabetes in the United States.

For patients with diabetes who have been recently hospitalized, black individuals have a significantly higher risk for readmission compared with other racial/ethnic groups, according to study results published in JAMA Network Open.

The retrospective study evaluated data from the OptumLabs Data Warehouse. The cohort included commercially insured adults or Medicare Advantage beneficiaries with a confirmed diagnosis of diabetes who were discharged from a hospital between January 1, 2009, and December 31, 2014 (N=272,758). Patients were stratified by race/ethnicity to assess whether rates of unplanned 30-day hospital readmission differed among white, black, Hispanic, and Asian individuals in the United States. Hospitalizations for a principal discharge diagnosis or medical treatment of cancer, pregnancy, or psychiatric disease were excluded, as were readmissions within 1 day of index admission.

The primary outcome was unplanned all-cause readmission within 30 days of discharge. The researchers also used statistical models to evaluate individual-, clinical-, economic-, index hospitalization–, and hospital-level risk factors for readmission.

During the 6-year study period, 467,324 index hospitalizations occurred. Patients had a mean age of 67.6±12.7 years.

Readmission rate was 10.2% for white patients, 12.2% for black patients, 10.9% for Hispanic patients, and 9.9% for Asian patients (P <.001).

After multivariate adjustment, the results indicated that only black individuals had an increased risk for readmission compared with white individuals (odds ratio, 1.05; 95% CI, 1.02-1.08).

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Compared with white patients, black and Hispanic patients had the highest observed-to-expected readmission rate ratios when they had lower income. For black and Hispanic patients with an annual household income <$40,000, the observed-to-expected ratio was 1.11 (95% CI, 1.09-1.14) and 1.11 (95% CI, 1.07-1.16), respectively.

Further, black and Hispanic patients had higher observed-to-expected readmission rate ratios compared with white patients when they were hospitalized in nonprofit or large hospitals (>400 beds). For black patients, the observed-to-expected ratios were 1.10 (95% CI, 1.08-1.12) and 1.11 (95% CI, 1.09-1.14) for nonprofit and large hospitals, respectively, and for Hispanic patients, these observed-to-expected ratios were 1.08 (95% CI, 1.05-1.12) and 1.09 (95% CI, 1.04-1.14), respectively.

The study had several limitations, including its retrospective design. The researchers also noted that while the OptumLabs Data Warehouse is one of the largest administrative claims data assets, it may not be representative of the US population as a whole.

“While this work does not provide solutions to the persistent disparities in readmission risk among black individuals with diabetes compared with white individuals with diabetes, it serves as a framework for future research and efforts aimed to reduce them,” the researchers wrote.

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Rodriguez-Gutierrez R, Herrin J, Lipska KJ, Montori VM, Shah ND, McCoy RG. Racial and ethnic differences in 30-day hospital readmissions among US adults with diabetes. JAMA Netw Open. 2019;2(10):e1913249.