title: Ethnic variations in unplanned readmissions and excess length of hospital stay: a nationwide record-linked cohort study.
abstract: BACKGROUND
  Studies in the USA have shown ethnic inequalities in quality of hospital care, but in Europe, this has never been analysed. We explored variations in indicators of quality of hospital care by ethnicity in the Netherlands.
  
  
  METHODS
  We analysed unplanned readmissions and excess length of stay (LOS) across ethnic groups in a large population of hospitalized patients over an 11-year period by linking information from the national hospital discharge register, the Dutch population register and socio-economic data. Data were analysed with stepwise logistic regression.
  
  
  RESULTS
  Ethnic differences were most pronounced in older patients: all non-Western ethnic groups > 45 years had an increased risk for excess LOS compared with ethnic Dutch patients, with odds ratios (ORs) (adjusted for case mix) varying from 1.05 [95% confidence intervals (95% CI) 1.02-1.08] for other non-Western patients to 1.14 (95% CI 1.07-1.22) for Moroccan patients. The risk for unplanned readmission in patients >45 years was increased for Turkish (OR 1.24, 95% CI 1.18-1.30) and Surinamese patients (OR 1.11, 95% CI 1.07-1.16). These differences were explained partially, although not substantially, by differences in socio-economic status.
  
  
  CONCLUSIONS
  We found significant ethnic variations in unplanned readmissions and excess LOS. These differences may be interpretable as shortcomings in the quality of hospital care delivered to ethnic minority patients, but exclusion of alternative explanations (such as differences in patient- and community-level factors, which are outside hospitals' control) requires further research. To quantify potential ethnic inequities in hospital care in Europe, we need empirical prospective cohort studies with solid quality outcomes such as adverse event rates.
authors: 1 Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors: Martine C
authors: MC
authors: de Bruijne
authors: Floor
authors: F
authors: van Rosse
authors: Ellen
authors: E
authors: Uiters
authors: Mariël
authors: M
authors: Droomers
authors: Jeanine
authors: J
authors: Suurmond
authors: Karien
authors: K
authors: Stronks
authors: Marie-Louise
authors: ML
authors: Essink-Bot
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology* / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D008913:Minority Groups / Q000706:statistics & numerical data; D009426:Netherlands / Q000453:epidemiology; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012042:Registries; D055815:Young Adult
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