Race, ethnicity and hospitalization for six chronic ambulatory care sensitive conditions in the USA
Race, ethnicity and hospitalization for six chronic ambulatory care sensitive conditions in the USA
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DOI：
10.1080/13557850600565640
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发表时间：
2006-08-01
影响因子：
3.1
通讯作者：
Laditka, Sarah B.
中科院分区：
文献类型：
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作者：
Laditka, James N.;Laditka, Sarah B.
目标.门诊护理敏感性疾病的住院，也称为可预防的住院，已被广泛接受为获得初级卫生保健和初级卫生保健系统总体成功的指标。我们的目标是研究美国可预防性住院与种族和民族之间的关系，分别针对六种主要慢性疾病：心绞痛、哮喘、慢性阻塞性肺疾病、充血性心力衰竭、糖尿病和高血压。我们使用1997年全国住院患者样本、1997年当前人口调查和1997年全国健康访谈调查，计算非裔美国人、西班牙裔和非西班牙裔白人的可预防住院率和门诊护理敏感性疾病的患病率。计算了19 - 64岁和65岁及以上年龄段的发病率。还估计了可解释基本住院模式的住院率。最后一组估计调整了疾病患病率的可预防住院率。非裔美国人和西班牙裔美国人的可接受住院率明显高于非西班牙裔白人，几乎所有的条件，无论是妇女和男子，以及两个年龄组。根据基础住院模式调整的发生率显示出类似的模式。根据患病率调整后，男女和两个年龄组的患病率差异仍然很大。尤其是对非洲裔美国人和西班牙裔美国人来说，因哮喘、糖尿病和高血压而可预防的住院治疗的风险更大。非裔美国人和西班牙裔美国人因主要慢性病可预防的住院率很高，即使考虑到疾病流行率和潜在的医院利用模式。哮喘、糖尿病和高血压的发病率特别高，而这些疾病是可以预防和管理的。我们的研究结果表明，需要改善非洲裔美国人和西班牙裔美国人在美国获得优质初级卫生保健，并加强有针对性的预防工作的支持。
Objectives. Hospitalization for ambulatory care sensitive conditions, also called preventable hospitalization, has been widely accepted as an indicator of access to primary health care, and of the overall success of the primary health care system. Our objective is to examine associations between preventable hospitalization and race and ethnicity in the USA, separately for six major chronic diseases: angina, asthma, chronic obstructive pulmonary disease, congestive heart failure, diabetes and hypertension.Design. We used the 1997 Nationwide Inpatient Sample, 1997 Current Population Survey and 1997 National Health Interview Survey, to calculate rates of preventable hospitalization, and the prevalence of ambulatory care sensitive conditions, for African Americans, Hispanics and non-Hispanic whites. Rates were calculated for ages 19 - 64, and 65 and over. Preventable hospitalization rates that accounted for underlying hospitalization patterns were also estimated. A final set of estimations adjusted the preventable hospitalization rates for disease prevalence.Results. Preventable hospitalization rates were notably higher for African Americans and Hispanics than for non-Hispanic whites for almost all of the conditions, both for women and men and for both age groups. Rates adjusted for underlying hospitalization patterns showed a similar pattern. Adjusted for disease prevalence, rate differences remained notably large for both women and men, and for both age groups. Particularly great, for both African Americans and Hispanics of both sexes, are the risks of preventable hospitalization for asthma, diabetes and hypertension.Conclusion. African Americans and Hispanics have high preventable hospitalization rates for major chronic conditions, even after disease prevalence and underlying hospital utilization patterns are considered. These rates are particularly high for asthma, diabetes and hypertension, which are amenable to prevention and management interventions. Our results suggest a need to improve access to quality primary health care for African Americans and Hispanics in the USA, and for enhanced support of targeted prevention efforts.