Differential Effects of Race and Poverty on Ambulatory Care Sensitive Conditions

This study is a continuation of an earlier study that examined hospitalization rates for ambulatory care sensitive (ACS) conditions, as a proxy for quality of care, and found evidence of a racial disparity among African American and White Medicare beneficiaries. The current study sought to determine whether neighborhood socioeconomic status (SES) explained this disparity. Differences in rates of ACS hospitalizations by race were assessed using Cochran-Mantel Haenszel tests and Poisson regression. Unadjusted rate ratios for ACS hospitalization for African Americans vs. Whites were found to be higher in low poverty areas (rate ratio (RR)=1.13; 95% CI (1.08, 1.17)) than in high poverty areas (RR=0.97; 95% CI (0.89, 1.05)). After controlling for various indicators of area SES in multivariate analyses race differences in ACS hospitalization rates persisted. Rural neighborhoods and those with higher percent of non-high school graduates were associated with greater risk of ACS hospitalizations

Racially Disproportionate Admission Rates for Ambulatory Care Sensitive Conditions in North Carolina

OBJECTIVE. This study examines race variations in quality of care through the proxy of ambulatory care sensitive (ACS) conditions. Hospital admission rates for eight ACS conditions were examined for African American and white Medicare beneficiaries in North Carolina. Temporal variations for ACS were also examined. METHOD. Enrollment and inpatient claims files from the Centers for Medicare and Medicaid Services (CMS) for a 1999–2002 cohort who were aged 65 years or older in 1999 were examined. Descriptive statistics were computed for each year. Cochran-Mantel Haenszel tests were performed to assess differences in the admission rates for both individual and aggregate ACS conditions controlling for time. The Cochran-Armitage test for trend was used to evaluate changes in admission rates over time. RESULTS. African Americans had higher admission rates for five of the eight ACS conditions. The highest rates were for diabetes among African Americans (odds ratio [OR]=2.86; 95% confidence interval [CI] [2.73, 2.99]) and adult asthma (OR=1.51; 95% CI [1.43, 1.61]). African Americans tended to have lower ACS admission rates than white patients for chronic obstructive pulmonary disease (OR=0.67; 95% CI [0.65, 0.69]); bacterial pneumonia (OR=0.86; 95% CI [0.84, 0.89]), and angina (OR=0.90; 95% CI [0.84, 0.97]). CONCLUSIONS. Using the ACS proxy for quality of health care as applied to examining race and ethnicity is a promising approach, though challenges remain. Admissions for ACS conditions between African American and white patients differ, but it is unclear why. This exploratory study must lead to an examination of social, economic, historical, and cultural factors for preventive, remedial, and beneficial policy initiatives