title: Ethnic disparities, hospital quality, and discharges against medical advice among patients with cardiovascular disease.
abstract: BACKGROUND
  Nationally, cardiovascular disease is the third-ranked disease category in terms of discharges against medical advice (AMA). Disparities in discharges AMA have not been examined among patients with cardiovascular disease, nor has the moderating role of hospital quality been studied.
  
  
  METHODS
  We examined the dual effect of race/ethnicity and hospital quality on discharges AMA by retrospectively analyzing hospital discharge data of patients who were admitted with a primary diagnosis of cardiovascular disease from 2000 through 2005.
  
  
  RESULTS
  A total of 2619 of the 312,183 hospitalizations for cardiovascular disease (.8%) resulted in a discharge AMA. The sample was 50% male, 32% non-White, and an average age of 68 years of age. Non-White race was associated with a higher probability of a discharge AMA in a high-quality hospital (adjusted odds ratio [AOR] 1.2, P < .001). Non-White race/ethnicity was associated with a lower probability of a discharge AMA in a low-quality hospital (AOR .8, P = .01). A discharge AMA was less likely at a high-quality hospital (AOR .7, P < .001), regardless of race/ethnicity. The modifying effect of hospital quality is more apparent at the highest levels of hospital quality.
  
  
  CONCLUSIONS
  Hospital quality is negatively correlated with discharges AMA and moderates the relationship between race/ethnicity and discharges AMA.
authors.affiliation: Pharmaceutical Health Services Research Department, University of Maryland School of Pharmacy, Baltimore, MD 21201, USA. eonukwug@rx.umaryland.edu
authors.forename: Ebere Chukwu
authors.initials: EC
authors.lastname: Onukwugha
authors.forename: Fadia T
authors.initials: FT
authors.lastname: Shaya
authors.forename: Elijah
authors.initials: E
authors.lastname: Saunders
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Weir
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000208:ethnology / Q000523:psychology / Q000628:therapy*; D015331:Cohort Studies; D005006:Ethnicity / Q000523:psychology* / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys; D054625:Healthcare Disparities; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008396:Maryland; D008875:Middle Aged; D010349:Patient Compliance / Q000208:ethnology*; D010351:Patient Discharge / Q000706:statistics & numerical data; D012189:Retrospective Studies; D044465:White People / Q000523:psychology* / Q000706:statistics & numerical data; D055815:Young Adult