Diabetic blacks, Hispanics face more hospitalizations

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Blacks and Hispanics are four to five times more likely than non-Hispanic whites to be hospitalized for uncontrolled diabetes and at least three times more likely to have diabetes-related, lower-extremity amputations, a federal study finds.

Such hospitalizations are "potentially preventable," and similarly large racial/ethnic disparities exist in terms of "preventable" hospitalizations for other chronic conditions, such as high blood pressure, says the U.S. Agency for Healthcare Research and Quality report.

It concludes that many people who comprise those two minority populations are not getting adequate primary and preventive care.

"The magnitude of these disparities was so high it surprised me," said Roxanne Andrews, an AHRQ researcher and an author of the report.

Excess hospitalizations deemed preventable "many times can result from a lack of access to good patient care," she said. "A lot of treatment can be provided in the outpatient setting."

No evidence exists of such a deficiency for Asians, given that the report showed their hospitalizations for poor diabetes control and resulting amputations, as well as high blood pressure, are lower than those of non-Hispanic whites.

In fact, hospitalization of elderly patients for asthma was the only indicator where rates were higher for Asians than for whites, the study found.

Data on hospitalization disparities come from analyses of the 2003 State Inpatient Databases, the most recent year such information is available. The database uses records from a sample of hospitals from 23 states.

In terms of hospitalizations for diabetes with long-term complications, the rate was 306.5 per 100,000 population among blacks and 245.6 per 100,000 among Hispanics. Those rates compared with 89.1 per 100,000 for non-Hispanic whites and 84.1 per 100,000 for Asians.

Hospitalization rates for diabetes-related foot amputations were 98.7 per 100,000 for blacks, 81.8 per 100,000 for Hispanics, 28.4 per 100,000 for whites and 19.2 per 100,000 for Asians.

Another racial/ethnic gap was found in hospitalizations for high blood pressure. In 2003, the rate for blacks was 98.7 per 100,000; for Hispanics, it was 81.8 per 100,000. In contrast, hospitalization rates of whites and Asians for that same condition were 31.8 per 100,000 and 29.1 per 100,000, respectively.

Preventable hospital admissions were highest for blacks for other conditions, including congestive heart failure, adult and pediatric asthma, perforated appendixes and dehydration.

Hispanics have the highest hospitalization rates for conditions such as asthma in the elderly, pediatric gastroenteritis and urinary tract infections.

"This is the first report that focuses on hospitalization disparities at the national level," Miss Andrews said. "We want to get a better handle on why these disparities occur and ... see how states are responding."