Length of Stay and Deaths in Diabetes-Related Preventable Hospitalizations Among Asian American, Pacific Islander, and White Older Adults on Medicare, Hawai‘i, December 2006–December 2010

full-text ►

Length of Stay and Deaths in Diabetes-Related Preventable Hospitalizations Among Asian American, Pacific Islander, and White Older Adults on Medicare, Hawai‘i, December 2006–December 2010

Prostate Cancer Screening

 

Prostate cancer is the most common cancer among American men. Share this e-card with the men in your life for more information prostate cancer risk factors and screening recommendations. .

Length of Stay and Deaths in Diabetes-Related Preventable Hospitalizations Among Asian American, Pacific Islander, and White Older Adults on Medicare, Hawai‘i, December 2006–December 2010

ORIGINAL RESEARCH — Volume 12 — August 6, 2015

Mary W. Guo, MPH; Hyeong Jun Ahn, PhD; Deborah T. Juarez, ScD; Jill Miyamura, PhD; Tetine L. Sentell, PhD

Suggested citation for this article: Guo MW, Ahn HJ, Juarez DT, Miyamura J, Sentell TL. Length of Stay and Deaths in Diabetes-Related Preventable Hospitalizations Among Asian American, Pacific Islander, and White Older Adults on Medicare, Hawai‘i, December 2006–December 2010. Prev Chronic Dis 2015;12:150092. DOI: http://dx.doi.org/10.5888/pcd12.150092.

PEER REVIEWED

On this Page

• Abstract
• Introduction
• Methods
• Results
• Discussion
• Acknowledgments
• Author Information
• References
• Tables

Abstract

Introduction

The objective of this study was to compare in-hospital deaths and length of stays for diabetes-related preventable hospitalizations (D-RPHs) in Hawai‘i for Asian American, Pacific Islander, and white Medicare recipients aged 65 years or older.

Methods

We considered all hospitalizations of older (>65 years) Japanese, Chinese, Native Hawaiians, Filipinos, and whites living in Hawai‘i with Medicare as the primary insurer from December 2006 through December 2010 (n = 127,079). We used International Classification of Diseases – 9th Revision (ICD-9) codes to identify D-RPHs as defined by the Agency for Healthcare Research and Quality. Length of stays and deaths during hospitalization were compared for Asian American and Pacific Islander versus whites in multivariable regression models, adjusting for age, sex, location of residence (Oahu, y/n), and comorbidity.

Results

Among the group studied, 1,700 hospitalizations of 1,424 patients were D-RPHs. Native Hawaiians were significantly more likely to die during a D-RPH (odds ratio [OR], 3.92; 95% confidence interval [CI], 1.42–10.87) than whites. Filipinos had a significantly shorter length of stay (relative risk [RR], 0.77; 95% CI, 0.62–0.95) for D-RPH than whites. Among Native Hawaiians with a D-RPH, 59% were in the youngest age group (65–75 y) whereas only 6.3% were in the oldest (≥85 y). By contrast, 23.2% of Japanese were in the youngest age group, and 32.2% were in the oldest.

Conclusion

This statewide study found significant differences in the clinical characteristics and outcomes of D-RPHs for Asian American and Pacific Islanders in Hawai‘i. Native Hawaiians were more likely to die during a D-RPH and were hospitalized at a younger age for a D-RPH than other studied racial/ethnic groups. Focused interventions targeting Native Hawaiians are needed to avoid these outcomes.

Acknowledgments

The research described was supported by the National Institute on Minority Health and Health Disparities (NIMHD) grant no. P20 MD000173 and was also supported in part by National Institutes of Health grant nos. U54MD007584 and G12MD007601, grant no. P20GM103466 from the Hawaii Statewide Research and Education Partnership, and grant no. RO1HS019990 from the Agency for Healthcare Research and Quality (AHRQ), US Department of Health and Human Services.

 Top

Author Information

Corresponding Author: Mary W. Guo, MPH, Office of Public Health Studies, University of Hawai‘i at Manoa, 1960 East-West Road, Biomed T102, Honolulu, HI 96822. Telephone: 808-956-9598. Email: maryguo@hawaii.edu.

Author Affiliations: Hyeong Jun Ahn, Biostatistics Core, John A. Burns School of Medicine, Honolulu, Hawai‘i; Deborah T. Juarez, Daniel K. Inouye College of Pharmacy, University of Hawai‘i at Hilo, Hilo, Hawai‘i; Jill Miyamura, Hawaii Health Information Corporation, Honolulu, Hawai‘i; Tetine L. Sentell, Office of Public Health Studies, University of Hawai‘i at Manoa, Honolulu, Hawai‘i.

 Top

References

1. McNeely MJ, Boyko EJ. Type 2 diabetes prevalence in Asian Americans: results of a national health survey. Diabetes Care 2004;27(1):66–9. CrossRef PubMed
2. Maskarinec G, Grandinetti A, Matsuura G, Sharma S, Mau M, Henderson BE, et al. Diabetes prevalence and body mass index differ by ethnicity: the Multiethnic Cohort. Ethn Dis 2009;19(1):49–55. PubMed
3. Grandinetti A, Kaholokula JK, Theriault AG, Mor JM, Chang HK, Waslien C. Prevalence of diabetes and glucose intolerance in an ethnically diverse rural community of Hawaii. Ethn Dis 2007;17(2):250–5. PubMed
4. Asian American and Pacific Islander Initiative. Asian American and Pacific Islander — primer; 2011. http://www.epa.gov/aapi/primer.htm. Accessed January 17, 2015.
5. Moy E, Greenberg LG, Borsky AE. Community variation: disparities in health care quality between Asian and white Medicare beneficiaries. Health Aff (Millwood) 2008;27(2):538–49.CrossRef PubMed
6. Wexler DJ, Nathan DM, Grant RW, Regan S, Van Leuvan AL, Cagliero E. Prevalence of elevated hemoglobin A1c among patients admitted to the hospital without a diagnosis of diabetes. J Clin Endocrinol Metab 2008;93(11):4238–44. CrossRef PubMed
7. Fraze TK, Jiang HJ, Burgess J. Hospital Stays for Patients with Diabetes, 2008. Healthcare Cost and Utilization Project Statistical Brief No. 93, August 2010. http://www.hcup-us.ahrq.gov/reports/statbriefs/sb93.pdf. Accessed July 10, 2015.
8. Jiang HJ, Russo CA, Barrett ML. Nationwide frequency and costs of potentially preventable hospitalizations. Healthcare Cost and Utilization Project (HCUP). Statistical Brief No.72, 2009. http://www.hcup-us.ahrq.gov/reports/statbriefs/sb72.jsp. Accessed July 10, 2015.
9. Moy E, Barrett M, Ho K; Centers for Disease Control and Prevention (CDC). Potentially preventable hospitalizations - United States, 2004-2007. MMWR Surveill Summ 2011;60(Suppl):80–3.PubMed
10. Sentell TL, Juarez DT, Ahn HJ, Tseng CW, Chen JJ, Salvail FR, et al. Disparities in diabetes-related preventable hospitalizations among working-age Native Hawaiians and Asians in Hawai‘i. Hawaii J Med Public Health 2014;73(12, Suppl 3):8–13. PubMed
11. National Breast Cancer Coalition. Outcomes measures or endpoints for clinical trials; 2013. http://www.breastcancerdeadline2020.org/breast-cancer-information/understanding-research/outcome-measures-or-endpoints.html. Accessed March 27, 2015.
12. Nirantharakumar K, Saeed M, Wilson I, Marshall T, Coleman JJ. In-hospital mortality and length of stay in patients with diabetes having foot disease. J Diabetes Complications 2013;27(5):454–8. CrossRef PubMed
13. Bueno H, Ross JS, Wang Y, Chen J, Vidán MT, Normand SL, et al. Trends in length of stay and short-term outcomes among Medicare patients hospitalized for heart failure, 1993–2006. JAMA 2010;303(21):2141–7. CrossRef PubMed
14. Kleinpell RM, Fletcher K, Jennings BM. Reducing functional decline in hospitalized elderly. In: Patient safety and quality: an evidence-based handbook for nurses. Hughes RG, editor. Rockville (MD): Agency for Healthcare Research and Quality; 2008 Apr.
15. Health Trends in Hawaii. Demographics — elderly pop growth in Hawaii. www.healthtrends.org/demo_elderly_pop.aspx. Accessed January 17, 2015.
16. Pobutsky A, Balabis J, Ngueyen D-H, Tottori C. Hawai‘i diabetes report 2010. Honolulu (HI): Hawai‘i State Department of Health, Chronic Disease Management and Control Branch, Diabetes Prevention and Control Program; 2011. http://www.Hawaiihealthmatters.org/javascript/htmleditor/uploads/DOH_DiabetesReport2010_Lo.pdf. Accessed January 17, 2015.
17. US Census Bureau. State and county quick facts — Hawaii; December 4, 2014. http://quickfacts.census.gov/qfd/states/15000.html. Accessed January 18, 2015.
18. Hawaii Health Information Corporation. Inpatient data. http://hhic.org/inpatient-data.asp. Accessed March 31, 2011.
19. Healthcare Cost and Utilization Project. NIS description of data elements; 2008. http://www.hcup-us.ahrq.gov/db/vars/race/nisnote.jsp. Accessed January 18, 2015.
20. Prevention quality indicators overview. Rockville (MD): Agency for Healthcare Research and Quality; 2011. http://www.qualityindicators.ahrq.gov/Modules/pqi_resources.aspx. Accessed January 18, 2015.
21. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40(5):373–83.CrossRef PubMed
22. Sentell TL, Ahn HJ, Miyamura J, Juarez D. Costs of preventable hospitalization for cardiovascular disease and diabetes in Asian Americans and Pacific Islanders. J Health Care Poor Underserved 2015;26(2 Suppl):63–82.
23. Koh H. The burden of diabetes on the Native Hawaiian and Pacific Islander community. Initiative on Asian Americans and Pacific Islanders; 2013. https://www.whitehouse.gov/blog/2013/11/19/burden-diabetes-native-hawaiian-and-pacific-islander-community. Accessed March 24, 2015.
24. Sloane BC, Zimmer CG. The power of peer health education. J Am Coll Health 1993;41(6):241–5. CrossRef PubMed
25. Kaholokula JK. It takes a community to eliminate obesity and diabetes disparities: the PILI ‘Ohana project. http://www2.jabsom.hawaii.edu/pili/includes/files/summit1.pdf. Accessed March 27, 2015.
26. Cooperative Extension Service. Diabetes Detection and Prevention Project. University of Hawaii at Manoa; 2006. http://www.ctahr.hawaii.edu/diabetes-ces. Accessed March 27, 2015.
27. Tomlin AM, Dovey SM, Tilyard MW. Risk factors for hospitalization due to diabetes complications. Diabetes Res Clin Pract 2008;80(2):244–52. Published online 2008 Feb 19 CrossRefPubMed
28. Moss SE, Klein R, Klein BE. Risk factors for hospitalization in people with diabetes. Arch Intern Med 1999;159(17):2053–7. CrossRef PubMed
29. Muenchberger H, Kendall E. Predictors of preventable hospitalization in chronic disease: priorities for change. J Public Health Policy 2010;31(2):150–63. CrossRef PubMed
30. Juarez DT, Samoa RA, Chung RS, Seto TB. Disparities in health, obesity and access to care among an insured population of Asian and Pacific Islander Americans in Hawai‘i. Hawaii Med J 2010;69(2):42–6. PubMed
31. Aitaoto N, Braun KL, Dang KL, So’a T. Cultural considerations in developing church-based programs to reduce cancer health disparities among Samoans. Ethn Health 2007;12(4):381–400.CrossRef PubMed
32. Robbins JM, Webb DA. Hospital admission rates for a racially diverse low-income cohort of patients with diabetes: the Urban Diabetes Study. Am J Public Health 2006;96(7):1260–4.CrossRef PubMed