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Racial Disparities in Potentially Avoidable Hospitalizations During the COVID-19 Pandemic
Richard K Leuchter1, Chad Wes A Villaflores2, Keith C Norris3
1Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California.
Insights
Potentially avoidable hospitalizations decreased overall during the COVID-19 pandemic, but racial disparities widened. African Americans experienced a smaller decrease in these hospitalizations compared to non-Hispanic Whites, indicating increased health inequities.
Area of Science:
- Health Services Research
- Health Disparities
- Epidemiology
Background:
- Potentially avoidable hospitalizations disproportionately affect racial and ethnic minorities, leading to iatrogenic harm and financial burden.
- Understanding changes in these hospitalizations by race and ethnicity during the COVID-19 pandemic is crucial for addressing health disparities.
Purpose of the Study:
- To analyze the changes in potentially avoidable hospitalizations stratified by race and ethnicity during the COVID-19 pandemic.
- To determine if racial disparities in potentially avoidable hospitalizations increased during the pandemic.
Main Methods:
- A single-center pre-post study design comparing March-August 2019 (prepandemic) to March-August 2020 (postpandemic).
- Inclusion of patients admitted to UCLA Health hospitals for ambulatory care-sensitive conditions.
- Measurement of potentially avoidable hospitalizations using Agency for Healthcare Research and Quality guidelines, stratified by race and ethnicity, with 95% CIs calculated via cluster bootstrap.
Main Results:
- Potentially avoidable hospitalizations decreased from 8.9% in 2019 to 7.2% in 2020.
- A significant decrease of 50.3% was observed among non-Hispanic Whites.
- A much smaller decrease of 8.0% was observed among African Americans, with a statistically significant difference between groups (p=0.015).
Conclusions:
- Racial disparities in potentially avoidable hospitalizations widened during the COVID-19 pandemic at a large urban health system.
- Prepandemic rates were already higher for racial and ethnic minorities, particularly African Americans.
- These findings warrant urgent attention and further investigation into the complex factors driving these disparities.
Introduction:
Potentially avoidable hospitalizations are disproportionately experienced by racial and ethnic minorities and expose these groups to unnecessary iatrogenic harm (including the risk of nosocomial COVID-19) and undue financial burden. In working toward an overarching goal of eliminating racial and ethnic health disparities, it is important to understand whether and to what extent potentially avoidable hospitalizations have changed by race and ethnicity during the COVID-19 pandemic.
Methods:
This single-center pre-post study included patients admitted to any UCLA Health hospital for an ambulatory care-sensitive condition between March-August 2019 (prepandemic period) and March-August 2020 (postpandemic period). Investigators measured the change in the number of potentially avoidable hospitalizations (defined per the Agency for Healthcare Research and Quality guidelines) stratified by race and ethnicity and calculated the 95% CIs for these hospitalizations using a cluster bootstrap procedure.
Results:
Between March 1, 2020 and August 31, 2020, 347 of 4,838 hospitalizations (7.2%) were potentially avoidable, compared with 557 of 6,248 (8.9%) during the same 6-month period in 2019. Potentially avoidable hospitalizations decreased by 50.3% (95% CI=41.2, 60.9) among non-Hispanic Whites but only by 8.0% (95% CI= -16.2, 39.9) among African Americans (50.3% vs 8.0%, p=0.015).
Conclusions:
Racial disparities in potentially avoidable hospitalizations increased during the COVID-19 pandemic at a large urban health system. Given that the prepandemic rates of potentially avoidable hospitalizations were already higher among racial and ethnic minorities, especially among African Americans, this finding should cause alarm and lead to further exploration of the complex factors contributing to these disparities.
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