Factors affecting the likelihood of a hospitalization following a diabetes‐related emergency department visit: A regional and urban‐rural analysis

• Published in: Journal of diabetes Vol. 12; no. 9; pp. 686 - 696
• Main Authors: Ferdinand, Alva O., Akinlotan, Marvellous A., Callaghan, Timothy, Towne, Samuel D., Bolin, Jane N.
• Format: Journal Article
• Language: English
• Published: Melbourne Wiley Publishing Asia Pty Ltd 01.09.2020; John Wiley & Sons, Inc
• Subjects: census regions; Diabetes; Emergency medical care; health disparities; Hospitalization; Minority & ethnic groups; Rural health care; rurality; Sociodemographics; Uninsured people; Urban health care; 乡村; 人口普查区域; 住院; 健康差异; 糖尿病; health disparities; Census regions; hospitalization; rurality; diabetes
• ISSN: 1753-0393; 1753-0407
• DOI: 10.1111/1753-0407.13066

Background The objective of this study is to examine place‐based and individual‐level predictors of diabetes‐related hospitalizations that stem from emergency department (ED) visits. Methods We conducted a pooled cross‐sectional analysis of the National Inpatient Sample (NIS) for 2009 to 2014 to identify ED‐initiated hospitalizations that were driven by the need for diabetes care. The odds of an ED‐initiated diabetes‐related hospitalization were assessed for the United States as a whole and separately for each census region. Results Nationally, residents of noncore areas (odds ratio [OR] 1.10; CI 1.08, 1.12), the South (OR 8.03; CI 6.84, 9.42), Blacks (OR 2.49; CI 2.47, 2.52), Hispanics (OR 2.32; CI 2.29, 2.35), Asians or Pacific Islanders (OR 1.20; CI 1.16, 1.23), Native Americans (OR 2.18; CI 2.10, 2.27), and the uninsured (OR 2.14; CI 2.11, 2.27) were significantly more likely to experience an ED‐initiated hospitalization for diabetes care. Census region‐stratified models showed that noncore residents of the South (OR 1.17; CI 1.14, 1.20) and Midwest (OR 1.06; CI 1.02, 1.11) had higher odds of a diabetes‐related ED‐initiated hospitalization. Conclusions As continued efforts are made to reduce place‐based disparities in diabetes care and management, targeted focus should be placed on residents of noncore areas in the South and Midwest, racial and ethnic minorities, as well as the uninsured population. 摘要 背景 本研究的目的是检验基于地点和个体水平的预测因素在急诊科就诊而导致的糖尿病相关住院。 方法 我们对2009年至2014年的全国住院患者样本(NIS)的横断面研究进行了合并分析, 以确定需进行糖尿病治疗的急诊住院。对整个美国和每个人口普查地区分别评估了急诊糖尿病相关住院的几率。 结果 在全国范围内, 非核心区居民(OR 1.10；CI 1.08, 1.12), 南方(OR 8.03；CI 6.84, 9.42), 黑种人(OR 2.49；CI 2.47, 2.52), 西班牙裔(OR 2.32；CI 2.29, 2.35), 亚洲人或太平洋岛民(OR 1.20；CI 1.16, 1.23), 美洲原住民(OR 2.18；CI 2.10, 2.27), 以及未参保者(OR 2.14；CI2.11, 2.27)更有可能经历急诊糖尿病住院治疗。人口普查区域分层模型显示, 南部(OR 1.17；CI 1.14, 1.20)和中西部(OR 1.06；CI 1.02, 1.11)的非核心居民与糖尿病相关的急诊住院几率更高。 结论 除了继续努力减少糖尿病护理和管理中基于地区差异, 应该有针对性地将重点放在南部和中西部非核心地区的居民, 种族和少数民族以及未参保的人群上。 Highlights There are variations in diabetes‐related hospitalizations that stem from emergency department visits. Rural residents, racial and ethnic minorities, the uninsured, and residents of the South and Midwest census regions of the United States are more likely to seek emergency care and be admitted for treatment of a primary diabetes diagnosis. Future research should continue to explore the effective interventions and services that can be offered to address the current health inequities facing at‐risk populations.