Elderly/Long-term Care

Elderly blacks' higher hospitalization rates for certain conditions suggest worse quality of outpatient care

When individuals are hospitalized for ambulatory care sensitive (ACS) conditions such as asthma exacerbations or diabetes complications, it may be a signal of poor outpatient care. A recent study found that elderly blacks in North Carolina are hospitalized for ACS conditions more than elderly whites, suggesting poorer outpatient quality of care among blacks. However, it is unclear what factors underlie these ethnic differences, notes Daniel L. Howard, Ph.D., of Shaw University.

Dr. Howard and colleagues used Medicare data from 1999 to 2002 to examine differences in hospitalization rates for eight ACS conditions among elderly persons: bacterial pneumonia, congestive heart failure (CHF), diabetes, chronic obstructive pulmonary disease (COPD), dehydration, urinary tract infection (UTI), angina, and asthma. Blacks were hospitalized at higher rates than whites for five of the eight conditions. Hospital admission rates for diabetes were nearly three times higher for blacks than whites, a difference that remained fairly consistent for all 4 years.

Blacks were also 43 percent more likely to be hospitalized for primary dehydration, 47 percent more likely to be hospitalized for UTI, and 51 percent more likely to be admitted to the hospital for asthma.

Even though admission rates for CHF declined between 2001 and 2002 for both whites and blacks, blacks were 41 percent more likely to be admitted for CHF than whites. However, blacks had a 14 percent lower rate of hospitalization for bacterial pneumonia, 33 percent lower rate for COPD, and 10 percent lower rate for angina. Proactive and early treatment of ACS conditions can lead to fewer trips to the emergency room and inpatient hospitalizations, note the researchers. They call for more studies to explore the many social and economic factors that may underlie racial differences in hospitalization for ACS conditions. Their study was supported in part by the Agency for Healthcare Research and Quality (HS13353).

See "Racially disproportionate admission rates for ambulatory care sensitive conditions in North Carolina," by Dr. Howard, Farrukh B. Hakeem, Ph.D., Christopher Njue, Ph.D., and others, in the May 2007 Public Health Reports 122, pp. 362-372.

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