Trends in Medical and Surgical Admission Length of Stay by Race/Ethnicity and Socioeconomic Status: A Time Series Analysis

Background: Length of stay (LOS), a metric of hospital efficiency, differs by race/ethnicity and socioeconomic status (SES) and longer LOS is associated with adverse health outcomes. Historically, projects to improve LOS efficiency have yielded LOS reductions by 0.3 to 0.7 days per admission. Objective: To assess differences in average adjusted length of stay (aALOS) over time by race/ethnicity, and SES stratified by discharge destination (home or non-home). Method: Data were obtained from 2009-2014 Healthcare Cost and Utilization Project State Inpatient Datasets for New York, New Jersey, and Florida. Multivariate generalized linear models were used to examine trends in aALOS differences by race/ethnicity, and by high vs low SES patients (defined first vs fourth quartile of median income by zip code) controlling for patient, disease and hospital characteristics. Results: For those discharged home, racial/ethnic and SES aALOS differences remained stable from 2009 to 2014. However, among those discharged to non-home destinations, Black vs White aALOS differences increased from 0.21 days in Q1 2009, (95% confidence interval (CI): 0.13 to 0.30) to 0.32 days in Q3 2013, (95% CI: 0.23 to 0.40), and for low vs high SES patients from 0.03 days in Q1 2009 (95% CI: -0.04 to 0.1) to 0.26 days, (95% CI: 0.19 to 0.34). Notably, for patients not discharged home, racial/ethnic and SES aALOS differences increased and persisted after Q3 2011, coinciding with the introduction of the Affordable Care Act (ACA). Conclusion: Further research to understand the ACA’s policy impact on hospital efficiencies, and relationship to racial/ethnic and SES differences in LOS is warranted.

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Trends in medical and surgical admission length of stay by race/ethnicity and socioeconomic status: a time series analysis

10.1101/2021.05.27.21257925 ◽

2021 ◽

Author(s):

Arnab K Ghosh ◽

Orysya Soroka ◽

Mark A Unruh ◽

Martin Shapiro

Keyword(s):

Socioeconomic Status ◽

Length Of Stay ◽

Median Income ◽

Adverse Health Outcomes ◽

Race Ethnicity ◽

The Impact ◽

Racial Ethnic ◽

Fourth Quartile ◽

Zip Code ◽

Surgical Admission

Length of stay, a metric of hospital efficiency, differs by race/ethnicity and socioeconomic status (SES). Longer LOS is associated with adverse health outcomes. We assessed differences in average adjusted length of stay (aALOS) over time by race/ethnicity, and SES stratified by discharge destination (home or non-home). Using the 2009-2014 State Inpatient Datasets from three states, we examined trends in aALOS differences by race/ethnicity, and SES (defined first vs fourth quartile of median income by zip code) controlling for patient, disease and hospital characteristics. For those discharged home, racial/ethnic and SES aALOS differences remained stable. Notably, for those discharged to non-home destinations, Black vs White, and low vs high SES aALOS differences increased significantly from 2009 to 2013, more sharply after Q3 2011, the introduction of the Affordable Care Act (ACA). Further research to understand the impact of the ACA on hospital efficiencies, and relationship to racial/ethnic and SES differences in LOS is warranted.

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The Effect of Patient and Hospital Characteristics on Total Costs of Peripheral Bypass in New York State

Vascular and Endovascular Surgery ◽

10.1177/1538574421993317 ◽

2021 ◽

pp. 153857442199331

Author(s):

Nicole Ilonzo ◽

Cody Goldberger ◽

Songhon Hwang ◽

Ajit Rao ◽

Peter Faries ◽

...

Keyword(s):

New York ◽

Length Of Stay ◽

Bypass Surgery ◽

New York State ◽

Severity Of Illness ◽

Factors Associated ◽

Peripheral Bypass ◽

Extreme Risk ◽

Risk Of Mortality ◽

Fourth Quartile

Introduction: With the aging U.S. population, peripheral vascular procedures will become increasingly common. The objective of this study is to characterize the factors associated with increased total costs after peripheral bypass surgery. Methods: Data for 34,819 patients undergoing peripheral bypass surgery in NY State were extracted using the Statewide Planning and Research Cooperative System (SPARCS) database for years 2009-2017. Patient demographics, All Patient Refined Diagnostic Related Groups (APR) severity score, mortality risk, hospital volume, and length of stay data were collected. Primary outcomes were total costs and length of stay. Data were analyzed using univariate and multivariate analysis. Results: 28.1% of peripheral bypass surgeries were performed in New York City. 7.9% of patients had extreme APR severity of illness whereas 32.0% had major APR severity of illness. 6.3% of patients had extreme risk of mortality and 1 in every 5 patients (20%) had major risk of mortality. 24.9% of patients were discharged to a facility. The mean length of stay (LOS) was 9.9 days. Patient LOS of 6-11 days was associated with +$2,791.76 total costs. Mean LOS of ≥ 12 days was associated with + $27,194.88 total costs. Multivariate analysis revealed risk factors associated with an admission listed in the fourth quartile of total costs (≥$36,694.44) for peripheral bypass surgery included NYC location (2.82, CI 2.62-3.04), emergency surgery (1.12, CI 1.03-1.22), extreme APR 2.08, 1.78-2.43, extreme risk of mortality (2.73, 2.34-3.19), emergency room visit (1.68, 1.57-1.81), discharge to a facility (1.27, CI 1.15-1.41), and LOS in the third or fourth quartile (11.09, 9.87-12.46). Conclusion: The cost of peripheral bypass surgery in New York State is influenced by a variety of factors including LOS, patient comorbidity and disease severity, an ER admission, and discharge to a facility.

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Factor Structure for Chronic Stress Before and During Pregnancy by Racial/Ethnic Group

Western Journal of Nursing Research ◽

10.1177/0193945918788852 ◽

2018 ◽

Vol 41 (5) ◽

pp. 704-727 ◽

Cited By ~ 1

Author(s):

Sangmi Kim ◽

Eun-Ok Im ◽

Jianghong Liu ◽

Connie Ulrich

Keyword(s):

New York ◽

Chronic Stress ◽

Physical Violence ◽

The United States ◽

Birth Certificates ◽

Specific Factor ◽

Pregnancy Risk ◽

Chronic Stressors ◽

Race Ethnicity ◽

Racial Ethnic

This study aimed to explore race/ethnicity-specific dimensionalities of chronic stress before and during pregnancy for non-Hispanic (N-H) White, N-H Black, Hispanic, and Asian women in the United States. This study analyzed the data among 6,850 women from the New York City and Washington State Pregnancy Risk Assessment Monitoring System (2004-2007) linked with birth certificates. Separate exploratory factor analysis was conducted by race/ethnicity using a maximum-likelihood extraction method with 26 chronic stress items before and during pregnancy. Correlations and internal consistency reliabilities among items and latent factors determined race/ethnicity-specific factor structures of chronic stress. Chronic stress was race/ethnicity-distinctive and multidimensional with low correlations among the factors ( r = .07-.28, p < .05). Despite financial hardship, perceived isolation, and physical violence underlying chronic stress among the racial/ethnic groups, intergroup variations existed under each group’s cultural or sociopolitical contexts. This study could help develop targeted strategies to intervene with women’s chronic stressors before childbirth.

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2625. Incidence of Bronchiolitis Requiring Hospitalization in the First 2 years of Life Among Healthy Term Infants with Different Races/Ethnicities: A Population-based Longitudinal Study

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.2303 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S914-S915

Author(s):

Kengo Inagaki ◽

Chad Blackshear ◽

Charlotte V Hobbs

Keyword(s):

New York ◽

Socioeconomic Status ◽

Proportional Hazards ◽

New York State ◽

Multivariable Analysis ◽

Population Based ◽

Cox Proportional Hazards ◽

Indigenous Populations ◽

Term Infants ◽

Race Ethnicity

Abstract Background Race/ethnicity is currently not considered a risk factor for bronchiolitis, except for indigenous populations in western countries. We sought to determine the incidence of hospitalization with bronchiolitis among different races/ethnicities, because such information can lead to more tailored preventive care. Methods We performed a population-based longitudinal observational study using the State Inpatient Database from New York state. Infants born between 2009 and 2013 at term without comorbidities were followed for the first 2 years of life, up to 2015. We calculated incidence among different race/ethnicity groups, and evaluated risks by developing Cox proportional hazards regression models. Results Of 877,465 healthy term infants, 10 356 infants were hospitalized with bronchiolitis. Overall, incidence was 11.8 per 1,000 births. Substantial difference in infants born in different seasons was observed (Figure 1). The incidence in non-Hispanic white, non-Hispanic black, Hispanic, and Asian infants was 8.6, 15.4, 19.1, and 6.5 per 1,000 births, respectively (table). On multivariable analysis adjusting for socioeconomic status, the risks remained substantially high among non-Hispanic black (hazard ratio [HR] 1.42, 95% confidence interval [CI]: 1.34–1.51) and Hispanic infants (HR 1.77, 95% CI: 1.67–1.87), particularly beyond 2–3 months of age, whereas Asian race was protective (HR 0.62, 95% CI: 0.56–0.69) (Figure 2, 3). Conclusion The risks of bronchiolitis hospitalization in the first 2 years of life was substantially higher among infants with non-Asian minority infants, particularly beyond 2–3 months of age. Further research efforts to identify effective public health interventions in each race/ethnic groups with varied socioeconomic status, such as improvement in access to care and anticipatory guidance, is warranted to overcome health disparity. Disclosures All authors: No reported disclosures.

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Adverse consequences of the COVID-19 pandemic on breast cancer stage distribution and breast cancer disparities.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.10555 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 10555-10555

Author(s):

Genevieve A. Fasano ◽

Yalei Chen ◽

Solange Bayard ◽

Melissa Davis ◽

Vivian Bea ◽

...

Keyword(s):

Breast Cancer ◽

New York ◽

New York City ◽

Cancer Patients ◽

York City ◽

Cancer Stage ◽

Breast Cancer Patients ◽

Stage Distribution ◽

Race Ethnicity ◽

Racial Ethnic

10555 Background: The COVID-19 surge in March 2020 resulted in a hiatus placed on screening mammography programs in support of shelter-in-place mandates and diversion of medical resources to pandemic management. The COVID-related economic recession and ongoing social distancing policies continued to influence screening practices after the hiatus was lifted. We evaluated the effect of the hiatus on breast cancer stage distribution on the diverse patient population of a health care system in New York City, the first pandemic epicenter in the United States. Methods: Breast cancer patients diagnosed January 1, 2019 to December 31, 2020 were analyzed, with comparisons of stage distribution and mammography screen-detection for three intervals: Pre-Hiatus, During Hiatus (March 15, 2020 to June 15, 2020), and Post-Hiatus. Results were stratified by African American (AA), White American (WA), Asian (As) and Hispanic/Latina (Hisp) self-reported racial/ethnic identity. Results: A total of 894 patients were identified; of these, 549 WA, 100 AA, 104 As, and 93 Hisp comprised the final race/ethnicity-stratified study population. Overall, 588 patients were diagnosed Pre-Hiatus, 61 During-Hiatus, and 245 Post-Hiatus. Nearly two-thirds (65.5%) of the Pre-Hiatus cases were screen-detected versus 49.2% During-Hiatus and 54.7% Post-Hiatus (p = 0.002). Frequency of tumors diagnosed < 1 cm declined from 41.9% Pre-Hiatus to 31.7% Post-Hiatus (p = 0.035). WA patients were more likely to have screen-detected disease compared to AA in the Pre-Hiatus period (69.1% vs. 56.1%; p = 0.05) but non-significantly more likely to have screen-detected disease compared to As and Hisp patients (66.2% vs. 56.9%; p = 0.08). In the Post-Hiatus period, the frequency of screen-detected disease was highest among WA patients (63.0%) compared to all other racial/ethnic groups (AA; 48.1%, As-33.3%, and Hisp-40%; p = 0.007). Similar patterns were observed for frequency of tumors diagnosed ≤1cm Pre-Hiatus (WA-44.3% vs AA-26%, p = 0.02; and vs. As-41.3%, Hisp-48%; p = 0.09), and Post-Hiatus (WA-37.7% vs. AA-18.2%, As-30.8%, Hisp-23.5%; p = 0.25). Conclusions: The 3-month pandemic-related mammography screening hiatus resulted in a more advanced stage distribution for New York City breast cancer patients, and worsened pre-existing race/ethnicity-associated disparities, especially for AA pts.

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Abstract P25: Identifying Socioeconomic Gradients and Racial/Ethnic Disparities in Outcomes From Ischemic Stroke Hospitalizations

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.4.suppl_1.ap25 ◽

2011 ◽

Vol 4 (suppl_1) ◽

Author(s):

Amresh D Hanchate ◽

Elaine Hylek ◽

Griffith Bell

Keyword(s):

Ischemic Stroke ◽

Low Income ◽

Ethnic Disparities ◽

P Value ◽

Median Income ◽

Lower Income ◽

Healthcare Outcomes ◽

Inpatient Mortality ◽

Race Ethnicity ◽

Racial Ethnic

OBJECTIVE Even though there are over half a million hospitalizations for acute stroke nationally each year, little attention has been paid to examining racial and ethnic disparities in outcomes, especially inpatient mortality and paralysis. The limited evidence available presents a somewhat confusing picture that is confounded by systematic differences in socioeconomic status (SES) across racial and ethnic populations. STUDY DESIGN We stratified all inpatient admissions for ischemic stroke in all civilian Texas hospitals in 2007 (N=21,203) by sex, age (44-64, 65-74, 75-84 and 85+), race/ethnicity (white, black, Hispanic and other) and zip-code median income (low income = poorest quartile zip codes). Inpatient mortality and paralysis were the outcomes of interest. Secondary diagnosis codes (ICD-9) were used to identify patient risk factors (including atrial fibrillation, hypertension, heart failure and diabetes). Pooled multilevel logistic regression models were estimated to measure mean differences in outcomes across SES and racial/ethnic cohorts. FINDINGS The overall outcome rates -- inpatient mortality=4.9%, paralysis=28.4% -- mask considerable systematic variation. Differences by race/ethnicity are relatively small and not statistically significant: 3.5% (whites), 2.9% (blacks) and 3.8% (Hispanics). However, lower income is associated with a substantially large increase in this risk. Same-race/ethnicity counterparts from lower income zip codes had 47% (whites), 67% (blacks) and 22% (Hispanic) higher inpatient mortality rate (p-value<0.05). Differences in risk adjusted rates of paralysis by race/ethnicity were also not statistically significant - 26% (whites), 29% (blacks) and 30% (Hispanics). But counterparts from lower income zip codes had 20% (whites), 7% (blacks) and 23% (Hispanic) higher rates of paralysis (p-values<0.05). CONCLUSION Among whites, blacks and Hispanics, those residing in poorer zip codes experienced substantially worse rates of inpatient mortality and paralysis. IMPLICATIONS Further study needs to explore the potential pathways connecting lower SES with poorer healthcare outcomes, including, greater patient severity, delayed treatment and access to quality care.

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Disparities in Peripheral Artery Disease Hospitalizations Identified Among Understudied Race-Ethnicity Groups

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.692236 ◽

2021 ◽

Vol 8 ◽

Author(s):

LaiTe Chen ◽

Donglan Zhang ◽

Lu Shi ◽

Corey A. Kalbaugh

Keyword(s):

Native American ◽

Length Of Stay ◽

Hospital Mortality ◽

Peripheral Artery Disease ◽

Pacific Islander ◽

Pacific Islanders ◽

Peripheral Artery ◽

Race Ethnicity ◽

Artery Disease ◽

Racial Ethnic

Background: To assess racial/ethnic differences in disease severity, hospital outcomes, length of stay and healthcare costs among hospitalized patients with peripheral artery disease (PAD).Methods: This study used data from the National Inpatient Sample (NIS) to explore the racial/ethnic disparities in PAD-related hospitalizations including presence of PAD with chronic limb threatened ischemia (CLI), amputation, in-hospital mortality, length of hospital stays and estimated medical costs. Race-ethnicity groups included non-Hispanic White, Black, Hispanic, Asian or Pacific Islander, Native American, and others (multiple races). Regression analyses adjusted for age, gender, Charlson Comorbidity Index, primary payer, patient location, bed size of the admission hospital, geographic region of the hospital, and rural/urban location of the hospital.Results: A total of 341,480 PAD hospitalizations were identified. Compared with non-Hispanic Whites, Native Americans had the highest odds of PAD with CLI (OR = 1.77, 95% CI: 1.61, 1.95); Black (OR = 1.71, 95% CI: 1.66, 1.76) and Hispanic (OR = 1.36, 95% CI: 1.31,1.41) patients had higher odds of amputation; Asian or Pacific Islanders had a higher mortality (OR = 1.20, 95% CI: 1.01,1.43), whereas Black (OR = 0.81, 95% CI: 0.76, 0.87) patients has a lower mortality; Asian or Pacific Islanders incurred higher overall inpatient costs (Margin = 30093.01, 95% CI: 28827.55, 31358.48) and most prolonged length of stay (IRR = 0.14, 95% CI: 0.09, 0.18).Conclusions: Our study identified elevated odds of amputation among Hispanic patients hospitalized with PAD as well as higher hospital mortality and medical expenses among Asian or Pacific Islander PAD inpatients. These two demographic groups were previously thought to have a lower risk for PAD and represent important populations for further investigation.

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Variation in early childhood parental investment in a US birth cohort: The effects of race, socioeconomic status and place.

10.31219/osf.io/8ev9a ◽

2016 ◽

Author(s):

Corey Sparks

Keyword(s):

Socioeconomic Status ◽

Early Childhood ◽

Birth Order ◽

Ethnic Groups ◽

Birth Cohort ◽

Parental Investment ◽

Residential Location ◽

Rural Residence ◽

Race Ethnicity ◽

Racial Ethnic

Parental investment can take many forms. This often takes the form of embodied capital. The ability to invest in a child may be compromised by the socioeconomic status, race/ethnicity and residential location of the parents. In addition, differential investment by sex may also play a role. This analysis uses data from a survey of children to examine disparities in parental investment by SES, race/ethnicity and residential location. Results indicate that after controlling for parental SES, children of certain racial/ethnic groups face a disparity in parental investment. This disparity is exacerbated by low parental SES, rural residence, sex and birth order.

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A transdisciplinary approach to understand the epigenetic basis of race/ethnicity health disparities

Epigenomics ◽

10.2217/epi-2020-0080 ◽

2021 ◽

Author(s):

Lucas A Salas ◽

Lauren C Peres ◽

Zaneta M Thayer ◽

Rick WA Smith ◽

Yichen Guo ◽

...

Keyword(s):

Socioeconomic Status ◽

Cancer Research ◽

Health Disparities ◽

Disease Burden ◽

Social Contexts ◽

Biological Anthropology ◽

Transdisciplinary Approach ◽

Wide Range ◽

Race Ethnicity ◽

Racial Ethnic

Health disparities correspond to differences in disease burden and mortality among socially defined population groups. Such disparities may emerge according to race/ethnicity, socioeconomic status and a variety of other social contexts, and are documented for a wide range of diseases. Here, we provide a transdisciplinary perspective on the contribution of epigenetics to the understanding of health disparities, with a special emphasis on disparities across socially defined racial/ethnic groups. Scientists in the fields of biological anthropology, bioinformatics and molecular epidemiology provide a summary of theoretical, statistical and practical considerations for conducting epigenetic health disparities research, and provide examples of successful applications from cancer research using this approach.

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