Key result
New Zealand Māori ethnicity was associated with 16% higher odds of unplanned readmission or death within 30 days of discharge compared with NZ European ethnicity (OR 1.16; 95% CI 1.08-1.24).
Why the study?
Does New Zealand Māori ethnicity increase the risk of unplanned readmission or death within 30 days of discharge compared to New Zealand European ethnicity in adult surgical patients?
Cohort (n=89,658)
Yes
Does New Zealand Māori ethnicity increase the risk of unplanned readmission or death within 30 days of discharge compared to New Zealand European ethnicity in adult surgical patients?
Odds Ratio: 1.16 (95% CI 1.08–1.24)
New Zealand Māori patients experience higher rates of 30-day unplanned readmission or death following surgery compared to New Zealand Europeans, indicating ethnic disparities in hospital care quality.
Highlights potential systemic inequities in post-surgical care requiring targeted quality improvement; leaves open the specific drivers.
OBJECTIVE: To compare the quality of hospital care for New Zealand (NZ) Māori and NZ European adult patients, using the rate of unplanned readmission or death within 30 days of discharge as an indicator of quality. DESIGN: Retrospective cohort study. SETTING: NZ public hospitals. PARTICIPANTS: Data from 89 658 patients who were admitted for one of a defined set of surgical procedures at NZ public hospitals 2002-8 were obtained from the NZ Ministry of Health. Outcome The odds of readmission for NZ Māori when compared with NZ European patients were calculated using logistic regression, incorporating variables for age, sex, comorbidity, index procedure, hospital volume and socioeconomic position. RESULTS: NZ Māori had 16% higher odds of readmission or death when compared with NZ European patients (OR = 1.16; 95% CI 1.08-1.24) after adjusting for all covariates. Readmission or death was also associated with being female (OR = 1.09; 1.03-1.15), older age (OR = 1.33; 1.19-1.48, for >79 years compared with 18-39 years), higher comorbidity (OR = 2.08; 1.89-2.31, for Charlson score 3+ compared with 0) and higher hospital volume (OR = 0.81; 0.76-0.86, for lowest volume compared with highest). CONCLUSIONS: This study suggests ethnic disparities in the quality of hospital care in NZ using unplanned readmission rate as an indicator of quality. There are well-documented differences in health outcomes between Māori and NZ Europeans, and it is possible that differential treatment within the health system contributes to these health status inequalities.
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Rumball‐Smith et al. (2013) conducted a cohort in Surgical procedures (n=89,658). New Zealand Māori ethnicity vs. New Zealand European ethnicity was evaluated on Unplanned readmission or death within 30 days of discharge (OR 1.16, 95% CI 1.08-1.24). New Zealand Māori ethnicity was associated with 16% higher odds of unplanned readmission or death within 30 days of discharge compared with NZ European ethnicity (OR 1.16; 95% CI 1.08-1.24).
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