Odds of 30-Day All-Cause Hospital Readmissions after Admission for Diabetic Lower Extremity Ulcer by Race and Ethnicity in Georgia, 2017 Open Access

Abstract

Background

Diabetic lower extremity ulcers (DLEU) are associated with significant healthcare utilization, including 30-day readmissions. Two previous studies have found no difference in 30-day readmissions after an index admission for DLEU by race and ethnicity for two small cohorts, while an administrative database analyses from New York and Florida found increased adjusted odds of 30-day all-cause readmission in Black and Hispanic people with DLEU. There is limited literature about 30-day readmissions related to DLEU in Georgia, a state along the “diabetes belt”. In our analysis, we examine the odds of 30-day all-cause readmissions after an admission for DLEU by race and ethnicity in Georgia in 2017.

Methods

We conducted a retrospective database analysis of the 2017 Georgia State Inpatient Database from the Agency for Healthcare Research and Quality. Individuals can be followed over the year in this database. We identified admissions with a diagnosis of DLEU at any position based on ICD-10 codes. Using unadjusted and adjusted logistic regression, we examined the odds of all-cause 30-day readmission following an initial admission for DLEU by race and ethnicity. 

Results

23,209 hospitalizations for DLEU were analyzed. 5,106 (22.0%) claims had all-cause readmissions within 30 days. 56% of the claims were from White patients, 38% from Black patients, 4% from Hispanic patients, 1% from Asian or Pacific Islander patients, and 2% from Native American or Other race and ethnicity patients. The unadjusted odds for all-cause 30-day readmission were higher in Black patients compared to White patients (OR 1.20, 95% CI 1.13, 1.27) and lower in Native American/Other patients compared to White patients (OR 0.78, 95% CI 0.61, 0.99). However, after adjusting for individual and hospital-level covariates, there was no difference in odds of all-cause 30-day readmission by race and ethnicity. 

Conclusion

In this study, individual-level and hospital-level covariates accounted for differences in all-cause 30-day readmissions after initial admission for DLEU by race and ethnicity. These factors reflect social and structural determinants of health, for which race and ethnicity often serves as a proxy. Capturing data related to social and structural determinants of health in datasets can help identify more accurate contributors to disparities. 

Table of Contents

Chapter 1: Literature Review      1

Chapter 2: Manuscript               9

Abstract                                     9

Introduction                               11

Methods                                     13

Results                                      18

Discussion                                 21

Conclusion                                 24

Tables and Figures                       25

Figure 1: Study Sample Development        25

Table 1: Patient's Demographic Characteristics and Hospital Characteristics for Each Inpatient Admission by Patient Race and Ethnicity, Georgia, 2017            26

Table 2 and Figure 2: Unadjusted and Adjusted Odds Ratios for 30-day Readmission after Index Admission for Diabetic Lower Extremity Ulcer by Race and Ethnicity    30

Table 3: Unadjusted and Adjusted Odd Ratios of Covariates for 30-day Readmission after Index Admission for Diabetic Lower Extremity Ulcer by Race and Ethnicity    32

Figure 3: Unadjusted Odd Ratios of Covariates for 30-day Readmission after Index Admission for Diabetic Lower Extremity Ulcer by Race and Ethnicity         35

Figure 4: Adjusted Odd Ratios of Covariates for 30-day Readmission after Index Admission for Diabetic Lower Extremity Ulcer by Race and Ethnicity            36

Table 4: Adjusted Odds Ratio for Sensitivity Analyses Endpoints after Admission for Diabetic Lower Extremity Ulcer        37

Chapter 3: Future Directions      38

References        40

Appendix          46

About this Master's Thesis

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School	Rollins School of Public Health
Department	Executive Masters of Public Health - MPH
Subfield / Discipline	Applied Epidemiology
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Epidemiology
Keyword	30-day hospital readmissions Diabetic lower extremity ulcer
Committee Chair / Thesis Advisor	Ali, Mohammed K., Emory University
Committee Members	Turbow, Sara, Emory University

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