Isolation inequity: Exploring race-based differences in hospital isolation duration

Isolation precautions are essential for preventing transmission of infectious diseases in healthcare settings but may be associated with unintended negative effects on patient care. Although racial and ethnic disparities have been documented across many healthcare processes and outcomes, their relationship to isolation precaution practices has not been well described. This study evaluated the association between patient race and ethnicity and duration of inpatient isolation precautions.

A retrospective observational cohort study was conducted in a 13-hospital academic healthcare system from November 2017 through December 2022. Gamma regression models were used to evaluate associations between isolation duration and patient race, ethnicity, age, sex, and isolation type. A sensitivity analysis excluded COVID-19-related Severe Respiratory isolation encounters to account for disproportionate disease burden.

Among 39,304 patients, 88.7% identified as White/Caucasian and 11.3% as non-White/non-Caucasian. In unadjusted analysis, non-White/non-Caucasian race was associated with 15% longer isolation duration compared with White/Caucasian race. After adjustment for age, sex, ethnicity, and isolation type, non-White/non-Caucasian race remained associated with 13% longer isolation duration. When Severe Respiratory isolation encounters were excluded, non-White/non-Caucasian race remained associated with 17% longer isolation duration.

Non-White/non-Caucasian race was independently associated with longer inpatient isolation duration. These findings suggest potential inequities in isolation experiences and highlight the need for further investigation into the clinical, operational, and structural factors contributing to observed differences.