Racial and Socioeconomic Disparities Among Inpatients With Acute Pancreatitis

Abstract

Introduction: Acute pancreatitis hospitalizations are a significant burden on US healthcare costs. The aim of this study was to assess disparities in healthcare resource utilization among races hospitalized with acute pancreatitis (AP). Methods: Using the 2013 Nationwide Inpatient Sample (NIS), all patients (≥18 years of age) were extracted if they had a primary diagnosis of AP. Healthcare resource utilization was compared between under-represented minorities (URMs) (blacks, hispanics) and white race based on income, type of insurance and type of hospital. Outcome measures included mortality, length of stay (LOS) (days) and cost (dollars). Patients were excluded if they had missing values for race or were listed as a race other than white, black or hispanic. Statistical analyses - SAS 9.4, Cary, NC. Results: A weighted sample of 241,390 inpatients were extracted (White N=167,595; Black N=43,075; Hispanic N=30,720). URM AP. Black and Hispanic patients are more likely to have Medicaid (26.48% and 24.65%; P<0.001, respectively). Black and Hispanic patients are more likely to present with diabetes (27.77% and 29.25%; P<0.001, respectively). Black patients are more likely to be admitted to an urban teaching hospital (57.50%; P<0.001). Black patients are more likely to present with comorbid alcohol abuse, drug abuse, hypertension, and renal failure (40.23%; P<0.001, 12.71%; P<0.001, 68.11%; P<0.001, 14.05%; P<0.001, respectively). Hispanic patients have higher costs ($10,484; P<0.001). White AP. White patients are more likely to be associated with high income (19.74%; P<0.001) and private insurance (34.27%; P<0.001). On multivariate analysis, after adjusting for patient and hospital characteristics, white patients have higher rates of mortality (OR 1.64; P=0.040), longer LOS (0.55 days; P<0.001) and higher costs ($1,021; P<0.001) as compared to black patients. In addition, there was no statistically significant difference in mortality, LOS, and cost based on the type of insurance. Conclusion: Racial disparities are evident among the different races hospitalized with AP. Blacks hospitalized with AP are more likely to be on Medicaid. Hispanic hospitalizations are associated with higher costs. While URMs hospitalized with AP are more likely to be associated with comorbid illness, white patients have longer LOS and a higher mortality. Further investigation of the etiology for these disparities is warranted.Figure