Racial Disparities in Hospital Readmissions

Elderly Medicare black patients have a higher 30-day hospital readmission rate than white patients for several conditions including congestive heart failure and pneumonia, according to findings published in the Journal of the American Medical Association.

"Reducing readmissions has become a policy focus because it represents an opportunity to simultaneously improve quality and reduce costs, yet little is known about racial disparities in this area," wrote the authors. "Understanding whether and why there are racial disparities in readmissions has implications for efforts to reduce readmissions."

In the study, Karen E. Joynt, MD, MPH, of the Harvard School of Public Health and Brigham and Women's Hospital, Boston, and colleagues conducted a study to determine whether black patients have higher odds of readmission than white patients and whether these disparities are related to where black patients receive care. Hospitals were categorized as "minority-serving" (the 10% of hospitals serving the highest number of black patients) or "non-minority serving" (the other 90% of hospitals).

Using national Medicare data gathered between 2006 and 2008, the researchers examined 30-day readmissions after hospitalization for acute myocardial infarction (MI), congestive heart failure (CHF), and pneumonia, and determined the odds of readmission for black patients compared with white patients at minority-serving vs. non-minority-serving hospitals. Of the nearly 3.2 million discharges in this data sample, 276,681 (8.7%) were for black patients and 2.9 million (91.3%) were for white patients. About 40% of black patients and 6% of white patients were treated at hospitals designated as minority-serving.

The researchers found that overall, black patients had 13% higher odds of all-cause 30-day readmission than white patients (24.8% vs. 22.6%) and patients discharged from minority-serving hospitals had 23% higher odds of readmission than patients from non-minority-serving hospitals (25.5% vs. 22.0%). Among patients with acute MI, black patients had 13% higher odds of readmission, irrespective of the site of care, while patients from minority-serving hospitals had 22% higher odds of readmissions, even accounting for patient race.

The authors also found that white patients at non-minority-serving hospitals consistently had the lowest odds of readmission and that black patients at minority-serving hospitals had the highest odds. Among patients with heart attack, using white patients at non-minority-serving hospitals as the reference group, black patients at minority-serving hospitals (35% higher odds), white patients at minority-serving hospitals (23% higher odds), and black patients at non-minority-serving hospitals (20% higher odds) had progressively higher odds of readmission. The results were similar for patients with CHF and pneumonia.

"We found that the association of readmission rates with the site of care was consistently greater than the association with race, suggesting that racial disparities in readmissions are, at least in part, a systems problem—the hospital at which a patient receives care appears to be at least as important as his/her race," the authors wrote. "Our findings that racial disparities in readmissions are related to both patient race and the site where care is provided should spur clinical leaders and policy makers to find new ways to reduce disparities in this important health outcome."