Trends and disparities in potentially preventable hospitalizations in non-Hispanic white and black adults in the U.S., 2001-2010

Introduction: Significant disparities have been noted between non-Hispanic whites and blacks in hospitalizations for several ambulatory sensitive conditions. The objectives of this study were to evaluate trends in potentially preventable hospitalizations (PPHs) among U.S. white and black adults and to assess whether improvements in disparities have occurred in these indicators of access to quality preventive care over the past decade.

Methods: We used a nationally weighted sample of hospitals from 37 states from the Healthcare Cost and Utilization Project to assess rates of PPHs for acute and chronic illnesses defined by the AHRQ Prevention Quality Indicators for years 2001-2010. Rates of PPHs were calculated using the AHRQ Prevention Quality Indicators.

Results: We observed a decline in PPHs during the study period, yet blacks maintained higher rates of PPHs compared to whites (rate ratio: acute -1.22, chronic – 3.09, overall  - 2.18). Rates of PPHs due to acute illnesses declined two-times faster in blacks (Annual %D=-4.58), compared to whites (Annual %D=-2.15). In both races, the highest rates of PPHs occurred among the elderly and patients from rural communities. There was a worsening black-white disparity in large metropolitan areas and among patients from highest income communities. High state-level variation was observed.

Conclusions: The results of this study reveal an overall decline in potentially preventable use of hospital inpatient care, a reverse in the trend from previous decades. Significant black-white disparities persist in rates of PPHs, indicating the need for continued efforts to target clinical and public interventions to address this disparity gap.