摘要：Objective. We sought to determine the frequency and costs of hospitalization and to assess possible racial/ethnic disparities in a large cohort of low-income patients with diabetes who had received primary care at municipal health clinics. Methods. Administrative data from Philadelphia Health Care Centers were linked with discharge data from Pennsylvania hospitals for March 1993 through December 2001. We tested differences in hospitalization rates and mean hospital charges by age, gender, and race/ethnicity. Results. A total of 18 800 patients with diabetes experienced 30 528 hospital admissions, for a hospitalization rate of 0.35 per person-year. Rates rose with age and with the interaction of male gender and age. Rates for non-Hispanic Whites were higher than those for African Americans, whereas those for Hispanics, Asian Americans, and “others” were lower. Patients who were hospitalized at least 5 times made up 10.5% of the study population and accounted for 64% of hospital admissions and hospital charges in this cohort. Conclusions. Hospitalization rates for this low-income cohort with access to primary care and pharmacy services were comparable to those of other diabetic patient populations, suggesting that reducing financial barriers to care may have benefited these patients. A subgroup of patients with multiple hospitalizations accounted for the majority of hospital admissions. Diabetes is one of the largest and fastest-growing causes of chronic disease mortality, morbidity, and disability in the United States. An estimated 18.2 million Americans had diabetes in 2002. 1 The number of diagnosed persons with diabetes has been projected to increase to almost 20 million by 2025. 2 The prevalence of diabetes has increased in all population groups, with the largest increases noted in people aged younger than 50 years. 1 In the United States, diabetes disproportionately affects African Americans and other racial/ethnic minorities and Americans of lower socioeconomic status regardless of race. 1 , 3 – 5 Diabetes is a treatable disease, and the benefits of appropriate treatment have been demonstrated in major clinical trials. 6 – 8 Nonetheless, surveys in a variety of populations and health care systems have found that most diabetic patients are not receiving optimal care or achieving recommended levels of glycemic control. 9 – 12 There is abundant evidence that African Americans and other minority patients and patients of lower socioeconomic status receive less intensive and poorer quality care across a number of major conditions 13 – 15 and experience poorer health status and health outcomes. However, we have limited information on possible disparities in outcomes among individuals with diabetes. 16 – 21 Hospitalization is both an adverse health event and a marker for serious health complications, and is often predictive of disability. 22 Persons with diabetes are admitted to hospitals substantially more frequently, and experience longer hospital stays, than nondiabetic individuals. 12 , 16 Diabetes is considered an ambulatory care–sensitive condition, and many hospitalizations are potentially preventable. 23 We sought to determine the frequency and costs of hospital admission in a large, unselected multiracial cohort of predominantly low-income patients with diabetes who had received primary care at municipal health clinics in Philadelphia over a period of 106 months, and to examine possible racial/ethnic disparities within this cohort.
