What is the clinical evidence from this study?

Study design: Cohort. Population: Asthma (n=17233). Intervention: Black race vs. White race. Primary outcome: 30-day readmission (OR 1.12, 95% CI 1.03 to 1.21).

January 4, 2024Journal of Translational Medicine7 citationsOpen Access

Racial differences in length of stay and readmission for asthma in the all of us research program

ECEsteban Correa-Agudelo YGYadu Gautam AMAngelico Mendy

Key Result

Black adults hospitalized for asthma had a 20% shorter length of stay but 12% higher odds of 30-day readmission compared to White adults.

Study Design

Type

Cohort (n=17,233)

Multicenter

Yes

Structured PICO

Are there racial disparities in length of stay and 30-day readmission for asthma hospitalizations?

Population

17,233 U.S. adults with asthma accounting for 82,188 inpatient and emergency department visits, analyzed to evaluate racial differences in length of stay and readmission.

Outcome

Length of stay (LOS) and 30-day readmission

Black patients hospitalized for asthma experience shorter lengths of stay but higher 30-day readmission rates compared to White patients, highlighting significant racial disparities in asthma care outcomes.

Main Result

Odds Ratio: 1.12 (95% CI 1.03–1.21)

Absolute Event Rate: 23.6% vs 20.4%

Limitations

Findings may not be generalizable to non-All of Us member institutions
Race/ethnicity was determined based on self-reported information
Sample sizes for Asian and Middle Eastern and North African populations were relatively small
Limited individual-level data available within the EHR, lacking clinical pathway information
Place-based deprivation estimate based only on last known area-level location, which may not accurately capture patient-level socioeconomic context
Relied on routinely collected ICD-9/ICD-10 billing codes, missing unobserved clinical factors

Abstract

BACKGROUND: This study addresses the limited research on racial disparities in asthma hospitalization outcomes, specifically length of stay (LOS) and readmission, across the U.S. METHODS: We analyzed in-patient and emergency department visits from the All of Us Research Program, identifying various risk factors (demographic, comorbid, temporal, and place-based) associated with asthma LOS and 30-day readmission using Bayesian mixed-effects models. RESULTS: Of 17,233 patients (48.0% White, 30.7% Black, 19.7% Hispanic/Latino, 1.3% Asian, and 0.3% Middle Eastern and North African) with 82,188 asthma visits, Black participants had 20% shorter LOS and 12% higher odds of readmission, compared to White participants in multivariate analyses. Public-insured patients had 14% longer LOS and 39% higher readmission odds than commercially insured patients. Weekend admissions resulted in a 12% shorter LOS but 10% higher readmission odds. Asthmatics with chronic diseases had a longer LOS (range: 6-39%) and higher readmission odds (range: 9-32%) except for those with allergic rhinitis, who had a 23% shorter LOS. CONCLUSIONS: A comprehensive understanding of the factors influencing asthma hospitalization, in conjunction with diverse datasets and clinical-community partnerships, can help physicians and policymakers to systematically address racial disparities, healthcare utilization and equitable outcomes in asthma care.

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