Key result
Native American/Alaskan Native race links to ~18-fold higher 90-day readmission odds versus white patients in direct care.
Why the study?
Diabetes readmissions are common and minority patients experience greater complication rates and lower quality healthcare, prompting examination of disparities within the universally insured Military Health System.
Cohort (n=784)
Yes
Universal healthcare access in the Military Health System may alleviate readmission disparities for black patients with diabetes, but Native American/Alaskan Native populations remain at higher risk.
Answers are grounded in this paper and cite their sources.
Persistent readmission disparity for Native American/Alaskan Native diabetes patients persists despite universal access; leaves open targeted mitigation strategies.
INTRODUCTION: Diabetes is one of the most common chronic conditions in the United States and has a cost burden over $120 billion per year. Readmissions following hospitalization for diabetes are common, particularly in minority patients, who experience greater rates of complications and lower quality healthcare compared to white patients. This study examines disparities in diabetes-related readmissions in the Military Health System, a universally insured, population of 9.5 million beneficiaries, who may receive care from military (direct care) or civilian (purchased care) facilities. METHODS: The study identified a population of 7,605 adult diabetic patients admitted to the hospital in 2014. Diagnostic codes were used to identify hospital readmissions, and logistic regression was used to analyze associations among race, beneficiary status, patient or sponsor's rank, and readmissions at 30, 60, and 90 days. RESULTS: A total of 239 direct care patients and 545 purchased care patients were included in our analyses. After adjusting for age and sex, we found no significant difference in readmission rates for black versus white patients; however, we found a statistically significant increase in the likelihood for readmission of Native American/Alaskan Native patients compared to white patients, which persisted in direct care at 60 days (adjusted odds ratio [AOR] 11.51, 95% CI 1.11-119.41) and 90 days (AOR 18.42, 95% CI 1.78-190.73), and in purchased care at 90 days (AOR 4.54, 95% CI 1.31-15.74). CONCLUSION: Our findings suggest that universal access to healthcare alleviates disparities for black patients, while Native America/Alaskan Native populations may still be at risk of disparities associated with readmissions among diabetic patients in both the closed direct care system and the civilian fee for service purchased care system.
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Frankel et al. (2020) conducted a cohort in Diabetes (n=784). Native American/Alaskan Native race vs. White race was evaluated on Hospital readmissions at 90 days (direct care) (AOR 18.42, 95% CI 1.78-190.73). Native American/Alaskan Native patients had a higher likelihood of 90-day readmission than white patients in direct care (AOR 18.42; 95% CI 1.78-190.73) and purchased care (AOR 4.54).
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