Ethnic Comparison of 30-Day Potentially Preventable Readmissions After Stroke in Hawaii.
Ethnic disparities in readmission after stroke have been inadequately studied. We sought to compare potentially preventable readmissions (PPR) among a multiethnic population in Hawaii.



Hospitalization data in Hawaii from 2007 to 2012 were assessed to compare ethnic differences in 30-day PPR after stroke-related hospitalizations. Multivariable models using logistic regression were performed to assess the impact of ethnicity on 30-day PPR after controlling for age group (<65 and ≥65 years), sex, insurance, county of residence, substance use, history of mental illness, and Charlson Comorbidity Index.



Thirty-day PPR was seen in 840 (8.4%) of 10 050 any stroke-related hospitalizations, 712 (8.7%) of 8161 ischemic stroke hospitalizations, and 128 (6.8%) of 1889 hemorrhagic stroke hospitalizations. In the multivariable models, only the Chinese ethnicity, compared with whites, was associated with 30-day PPR after any stroke hospitalizations (odds ratio [OR] [95% confidence interval {CI}], 1.40 [1.05-1.88]) and ischemic stroke hospitalizations (OR, 1.42 [CI, 1.04-1.96]). When considering only one hospitalization per individual, the impact of Chinese ethnicity on PPR after any stroke hospitalization (OR, 1.22 [CI, 0.89-1.68]) and ischemic stroke hospitalization (OR, 1.21 [CI, 0.86-1.71]) was attenuated. Other factors associated with 30-day PPR after any stroke hospitalizations were Charlson Comorbidity Index (per unit increase) (OR, 1.21 [CI, 1.18-1.24]), Medicaid (OR, 1.42 [CI, 1.07-1.88]), Hawaii county (OR, 0.78 [CI, 0.62-0.97]), and mental illness (OR, 1.37 [CI, 1.10-1.70]).



In Hawaii, Chinese may have a higher risk of 30-day PPR after stroke compared with whites. However, this seems to be driven by the high number of repeated PPR within the Chinese ethnic group.
From the Neuroscience Institute, The Queen's Medical Center, Honolulu, HI (K.N.); Department of Medicine, John A. Burns School of Medicine (K.N.), Office of Biostatistics and Quantitative Health Sciences, John A. Burns School of Medicine (H.J.A.), Office of Public Health Studies (T.L.S.), University of Hawaii, Honolulu; Daniel K. Inouye College of Pharmacy, University of Hawaii, Hilo (D.A.T.); and Hawaii Health Information Corporation, Honolulu (J.M.). kazuma.nakagawa@hawaii.edu.
Kazuma
K
Nakagawa
From the Neuroscience Institute, The Queen's Medical Center, Honolulu, HI (K.N.); Department of Medicine, John A. Burns School of Medicine (K.N.), Office of Biostatistics and Quantitative Health Sciences, John A. Burns School of Medicine (H.J.A.), Office of Public Health Studies (T.L.S.), University of Hawaii, Honolulu; Daniel K. Inouye College of Pharmacy, University of Hawaii, Hilo (D.A.T.); and Hawaii Health Information Corporation, Honolulu (J.M.).
Hyeong Jun
HJ
Ahn
From the Neuroscience Institute, The Queen's Medical Center, Honolulu, HI (K.N.); Department of Medicine, John A. Burns School of Medicine (K.N.), Office of Biostatistics and Quantitative Health Sciences, John A. Burns School of Medicine (H.J.A.), Office of Public Health Studies (T.L.S.), University of Hawaii, Honolulu; Daniel K. Inouye College of Pharmacy, University of Hawaii, Hilo (D.A.T.); and Hawaii Health Information Corporation, Honolulu (J.M.).
Deborah A
DA
Taira
From the Neuroscience Institute, The Queen's Medical Center, Honolulu, HI (K.N.); Department of Medicine, John A. Burns School of Medicine (K.N.), Office of Biostatistics and Quantitative Health Sciences, John A. Burns School of Medicine (H.J.A.), Office of Public Health Studies (T.L.S.), University of Hawaii, Honolulu; Daniel K. Inouye College of Pharmacy, University of Hawaii, Hilo (D.A.T.); and Hawaii Health Information Corporation, Honolulu (J.M.).
Jill
J
Miyamura
From the Neuroscience Institute, The Queen's Medical Center, Honolulu, HI (K.N.); Department of Medicine, John A. Burns School of Medicine (K.N.), Office of Biostatistics and Quantitative Health Sciences, John A. Burns School of Medicine (H.J.A.), Office of Public Health Studies (T.L.S.), University of Hawaii, Honolulu; Daniel K. Inouye College of Pharmacy, University of Hawaii, Hilo (D.A.T.); and Hawaii Health Information Corporation, Honolulu (J.M.).
Tetine L
TL
Sentell
D000367:Age Factors; D000368:Aged; D002545:Brain Ischemia / Q000208:ethnology* / Q000628:therapy; D005006:Ethnicity; D005260:Female; D006254:Hawaii; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000208:ethnology* / Q000628:therapy
attention; hospitalization; minority health; patient readmission; stroke