Economic and clinical disparities in hospitalized patients with type 2 diabetes.
OBJECTIVE
To identify and describe economic and clinical relationships and trends associated with selected access, equity, and outcome characteristics of a large inpatient population with Type 2 diabetes.


METHODS
Longitudinal, descriptive cross-sectional study with secondary analyses of data about 101,944 patients in hospitals in the United States (US), 40 years of age and older with a primary diagnosis of Type 2 diabetes from the Health Care Cost and Utilization Project (HCUP-3) database for 1994-1997.


METHODS
Descriptive analysis, hierarchical, random-effects regression modeling, and contrasts between covariate-adjusted means. Hospital charge data were highly skewed in a positive direction requiring a logarithmic transformation. Variables for the study included both hospital and patient characteristics.


RESULTS
Significant racial and sex disparities were found in health care access, equity, and outcomes, with equity characteristics showing alarming disparities in types of procedures (amputations and peripheral vascular bypass grafts) performed, lengths of stay, and dispositions.


CONCLUSIONS
Disparities in health care access, equity, and outcomes continue to exist on the basis of sex, ethnicity, and age as well as the type and location of the hospital. Access and equity are values that, despite rhetoric in relation to health care utilization, have not been systematically attained.
Dowell
Marsha A
MA
College of Nursing, University of Alabama, Huntsville, AL, USA. dowellm@uah.edu
Rozell
Billie
B
Roth
David
D
Delugach
Harry
H
Chaloux
Patricia
P
Dowell
Jennifer
J
D000368:Aged; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000191:economics / Q000453:epidemiology / Q000628:therapy; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000191:economics / Q000592:standards; D006304:Health Status; D017722:Hospital Charges / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000458:organization & administration; D044469:Racial Groups / Q000706:statistics & numerical data; D012044:Regression Analysis; D017678:Sex Distribution; D012737:Sex Factors; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology