Severity of illness and length of stay for inpatient mental health hospitalizations for Asian American and Pacific Islander subgroups in Hawaii

Background: This study compared severity of illness (SOI) and length of stay (LOS) for mental health hospitalizations in 4 Asian American/Pacific Islander (AA/PI) subgroups and Whites for any mental health diagnosis and across 5 diagnostic groups (schizophrenia, depression, bipolar disorder, anxiety disorders, and other). Methods: 2006-2010 Hawai'i Health Information Corporation data, which includes all-payer diagnostic-related groups and other data on all hospitalizations in Hawaii, was used for those >=18 years. SOI was measured on a 4-point scale (higher is worse). Generalized linear models predicted SOI and LOS, adjusting for gender, age, payer, and Oahu residence.

Results: In univariate analyses of mental health hospitalizations overall, LOS was lowest among whites (7.05 days), followed by Native Hawaiians (7.23), Filipinos (8.82), Japanese (10.25), and Chinese (11.44) (p<0.0001). SOI was also lowest among whites and Native Hawaiians (1.58), followed by Filipinos (1.67), Chinese (1.71) and Japanese (1.82) (p<0.0001). In multivariate analyses, LOS remained significantly (p<0.01) longer for Chinese, Filipinos, and Japanese compared to Whites and SOI remained significantly (p<0.05) higher for Filipinos, Hawaiians, and Japanese. Different patterns were seen within diagnostic groups. Chinese and Japanese had longer LOS and Filipinos and Japanese had higher SOI for schizophrenia compared to Whites. Filipinos and Japanese had higher SOI for depression than Whites. No differences were observed for anxiety or bipolar disorder.

Conclusions: Although evidence indicates that AA/PI subgroups have lower rates of mental health hospitalization than Whites, when these hospitalizations occur, three out of four AA/PI subgroups experienced higher SOI and longer LOS relative to Whites.