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Health Services Research & Development

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2006 HSR&D National Meeting Abstract

1006 — Racial Disparities in Preventable Hospitalization In Community-Dwelling Veterans with Dementia

Author List:
Van Houtven CH (Center for Health Services Research in Primary Care, Durham)
Thorpe JM (Duke School of Nursing)
Sleath B (University of North Carolina at Chapel Hill)
Clipp EC (GRECC, Durham VAMC, Duke School of Nursing)

Hospitalizations for ambulatory care sensitive conditions (ACSC) such as diabetes and hypertension are considered preventable with access to timely, effective outpatient care. ACSC hospitalizations may indicate barriers to high-quality ambulatory care. We explored racial disparities in ACSC hospitalizations in a vulnerable, rapidly expanding, VA population—community-residing veterans with dementia.

VA inpatient utilization was linked to data from the 1998 National Longitudinal Caregiver Survey. The sample consisted of 1,813 community-dwelling older male veterans with dementia and their co-residing female caregivers. We used the Andersen Behavioral Model of Health Service use (BMHSU) to identify potential mediators behind racial differences in ACSC hospitalizations. To disentangle the effects of race and other BMHSU factors, variables were entered into a logistic regression model in stages: (1) race alone, (2) race and predisposing factors, (3) race, predisposing, and underlying medical need, and (4) race, predisposing, underlying medical need, and enabling factors.

208 of the 1,813 veterans (11.5%) had a total of 303 ACSC hospitalizations over the two-year period. African-American veterans were more likely to have had an ACSC hospitalization compared to white veterans (17.5% versus 10.4%; unadjusted odds ratio [OR]=1.82; p<.01). The addition of predisposing factors did not eliminate the disparity (OR=1.67; p<.01), nor did underlying medical need (OR=1.57; p=.029). The addition of enabling factors, however, reduced the disparity to statistically non-significant levels (OR=1.29; p=.241). Stratified by veteran race, the effects of caregiver psychological distress on likelihood of an ACSC hospitalization differed by race. African-American veterans with distressed caregivers were 3.4 times more likely to have an ACSC hospitalization compared to veterans with non-distressed caregivers (OR=3.35, p<.01), whereas white veterans with distressed caregivers were less likely (OR=0.59, p<.01) to have an ACSC hospitalization.

African-American veterans with dementia were more likely to be hospitalized for an ambulatory sensitive condition, and this disparity was largely explained by differences in enabling factors (e.g., insurance, income, caregiver distress, social support, distance). The effect of caregiver psychological distress differed significantly by veteran race.

Increasing enabling resources and reducing caregiver distress in African-American veterans may mitigate racial differences in potentially preventable hospitalizations among community-dwelling veterans with dementia.

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