Discharges against medical advice: are race/ethnicity predictors?
BACKGROUND
Prior literature suggests that blacks are more likely to be discharged against medical advice (DAMA).


OBJECTIVE
We examined whether DAMA from general hospitals varies by race/ethnicity and whether this variation is explained by individual and hospital factors. DESIGN, SUBJECTS, AND MEASUREMENTS: We conducted cross-sectional analyses of 1998 to 2000 hospital discharge data, linked to the American Hospital Association data, on adults admitted for acute general hospital care in California, Florida, and New York. A series of hierarchical logistic regression analyses explored factors associated with DAMA, initially adjusting for age and gender, then sequentially adding adjustment for comorbidities, individual socio-economic factors, and finally hospital characteristics.


RESULTS
Compared with whites, blacks had a 2-fold higher age-gender adjusted odds of DAMA, a risk that progressively diminished with increasing adjustment (final adjusted odds ratio [OR] = 0.95, 95% confidence interval [CI] = 0.91, 1.00). While Hispanics had an increased risk of DAMA in age-gender-adjusted analyses, the final model revealed a protective effect (adjusted OR = 0.66, 95% CI = 0.62, 0.70), similar to that observed for Asians.


CONCLUSIONS
Disparities in DAMA affecting minority patients in general hospitals are largely accounted for by individual and hospital socio-economic factors. The absence of any adjusted disparity affecting blacks, and the protective effect observed for Hispanics and other minorities suggest that individual discrimination and poor communication are not primary determinants of DAMA, but where patients are admitted does contribute to disparities in DAMA.
Franks
Peter
P
Department of Family & Community Medicine, Center for Health Services Research in Primary Care, University of California at Davis, Sacramento, California 95817, USA. pfranks@ucdavis.edu
Meldrum
Sean
S
Fiscella
Kevin
K
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D044383:Black People / Q000706:statistics & numerical data; D002140:California; D005260:Female; D005431:Florida; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006769:Hospitals, General / Q000706:statistics & numerical data; D006801:Humans; D019458:Insurance Coverage; D008297:Male; D008875:Middle Aged; D009518:New York; D016017:Odds Ratio; D010352:Patient Dropouts / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D016312:Treatment Refusal / Q000208:ethnology* / Q000706:statistics & numerical data; D044465:White People / Q000706:statistics & numerical data; D001741:Black or African American