Racial gap in preventive care found to increase hospitalizations

Uncontrolled diabetes leads blacks to require hospitalization an average 12 years earlier than white diabetics.

By Kevin B. O’Reilly — Posted Dec. 18, 2009

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Patients with chronic conditions such as diabetes can avoid hospitalization with good primary care, medical experts say. But black patients with diabetes are hospitalized about five years earlier than are white diabetics, showing yet another area of health care delivery in which racial disparities seem to prevail.

Researchers at Yale University in Connecticut examined a nationally representative sample of 6,815 hospital discharges from 2005 and found that the disparities persisted even after adjusting for gender, marital status, hospital region and payment type.

"Racial disparities across nearly all health outcomes are well-documented -- from premature birth to premature death," said Jeanette R. Ickovics, PhD, director of the social and behavioral sciences program at the Yale University School of Public Health. "Our study adds perspective to one important aspect of health: premature hospitalization. Health inequity is a result, in part, of social, educational, economic and health care access disparities between blacks and whites [that has] a deep history in the U.S."

The study will appear in the January American Journal of Preventive Medicine, the journal of the American College of Preventive Medicine and the Assn. for Prevention Teaching and Research.

The biggest gap is in uncontrolled diabetes, where black patients, on average, are hospitalized at age 52, 12 years earlier than are white patients. Researchers also examined premature hospitalization for conditions such as asthma, hypertension, congestive heart failure and acute conditions, including urinary tract infection. The disparities are not explained by underlying differences in the populations, the study said.

"Ambulatory care physicians must focus on vigilant early identification and early intervention," Ickovics said, but added that disparities are best addressed at a systemic level.

"We need to recognize that health is more than just health care," she said. "We need sustainable policies that make an investment in communities and families, particularly those experiencing socioeconomic disadvantages."

Such policies include routine screening of patients for diet issues, physical activity and tobacco use, as well as making it easier for people who live in low-income areas to access healthier foods and exercise in safe public areas.

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