Racial Disparities in Hospital Re-admissions in Diabetes Patients

Previous studies have observed racial disparities in hospital readmission rates, but data have not established this in patients with diabetes. In this retrospective cohort study, researchers analyzed racial differences in all-cause readmission rates in adult patients with diabetes, and they further evaluated patient- and system-level factors correlated with these disparities. Data were collected on commercially insured and Medicare Advantage patients in the U.S. Between Jan. 1, 2009, and Dec. 31, 2014, 272,758 adult patients (mean [SD] age, 67.7 [12.7] years; 52.6% were female) with diabetes were discharged alive from the hospital; these patients were stratified by race/ethnicity. The primary outcome measures included all-cause 30-day readmission and individual-, clinical-, economic-, index hospitalization–, and hospital-level readmission risk factors. A total of 467,324 index hospitalizations in the patient cohort were identified. Rates of 30-day all-cause readmission by race were 10.2% for white patients, 12.2% for black patients, 10.9% for Hispanic patients, and 9.9% for Asian patients. In adjusted analyses, the only patients with a higher readmission risk compared to white patients were black patients (OR=1.05; 95% CI; 1.02 to 1.08); this was only partially explained by other demographic factors, comorbidities, income, reason for index hospitalization, or place of hospitalization. The observed-to-expected (OE) readmission rate ratio, compared to white patients, was highest among low-income (annual household income <$40,000) black (OE ratio, 1.11; 95% CI, 1.09 to 1.14) and Hispanic (OE ratio=1.11; 95% CI, 1.07 to 1.16) patients, as well as black and Hispanic patients hospitalized in nonprofit (black patients: OE ratio, 1.10; 95% CI, 1.08 to 1.12; Hispanic patients: OE ratio, 1.08; 95% CI, 1.05 to 1.12), academic (black patients: OE ratio, 1.16; 95% CI, 1.13 to 1.20; Hispanic patients: OE ratio, 1.12; 95% CI, 1.06 to 1.19), or large (≥400 beds; black patients: OE ratio, 1.11; 95% CI, 1.09 to 1.14; Hispanic patients: OE ratio, 1.09; 95% CI, 1.04 to 1.14) hospitals.