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Healthcare Utilization Disparity between Caucasian and African-American Patients with Diabetes from 2006-2008 and 2009-2011

Anand Shetty, Michal Parzuch, Shijo Nirappil, Ali Kicklighter and Paige Lager

Objective: Type II Diabetes Mellitus has attached concern worldwide because of its impact on those with the disease, the growing costs to health systems, and chronic complications and comorbidities of the disease. The purpose of this study was to identify disparity of utilization of healthcare services among African Americans and Caucasians in the United States from 2006-2008 and 2009 and 2011.
Design: Retrospective demographic data was acquired from the Medicare database via the Center for Medicare and Medicaid Services (CMS) from 2006- 2011 using files derived from inpatient charts and insurance carrier data was analyzed by independent t-test.
Subjects: The sample from 2006-2008 included men and women; 181,857 Caucasians and 29,527 African Americans. The sample from 2009-2011, included 140,172 Caucasians and 23,898 African Americans. Main Outcome Measures: Number of hospital stays, length of hospital stay, number of physician office visits, number of physical therapy visits, and incidence of lower limb amputations. Results: An analysis of temporal changes in these populations revealed that the mean number of hospital stays decreased from 3.05 to 2.05 for African Americans and from 2.63 to 1.86 for Caucasians, P<0.001. The length of hospital stays decreased for African Americans from 21.11 to 15.61 days and in Caucasians from 13.87 to 11.01 days. The number of lower limb amputations decreased for both groups, but African Americans saw a more significant drop from 1.6% to 0.7%. The mean number of doctor visits for African Americans decreased from 21.28 to 8.91 and Caucasians from 24.72 to 9.59. The mean number of physical therapy visits in African Americans decreased 19.56 to 17.19 and Caucasians 25.15 to 20.91.
Conclusion: Health care disparities in the utilization of health care for DMII exist between African Americans and Caucasians. Caucasians are more likely to visit physicians and physical therapists while African Americans are more likely to go to hospitals, stay longer in hospitals, and have lower limb amputations. The causes of these disparities between African Americans and Caucasians require further investigation for complete understanding.