Poor Self-Rated Health Is Associated with Hospitalization and Emergency Department Visits in African American Older Adul
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Poor Self-Rated Health Is Associated with Hospitalization and Emergency Department Visits in African American Older Adults with Diabetes Shervin Assari 1
&
James Smith 2 & Mohsen Bazargan 2,3
Received: 12 June 2019 / Revised: 17 January 2020 / Accepted: 26 January 2020 # W. Montague Cobb-NMA Health Institute 2020
Abstract Objectives We investigated the associations between poor self-rated health (SRH), hospitalization, and emergency department (ED) visits among African American older adults with diabetes mellitus (DM). Methods This survey recruited 235 non-institutionalized African American older adults (age > = 55 years) with diabetes mellitus (DM). Participants were recruited using a convenience sample from economically disadvantaged urban areas of South Los Angeles, California. Poor SRH was the independent variable. Hospitalization and ED visits in the past 12 months were the outcomes. Demographic factors, health [comorbid medical conditions (CMCs) and polypharmacy], health behaviors (smoking and drinking), and access (difficulty accessing care, dissatisfaction with the medical care, routine source of care, and visiting the same doctor) were confounders. Binary logistic regressions were used for data analysis. Results Poor SRH was associated with higher odds of hospitalization and ED visit, while all covariates were controlled. Conclusions Poor SRH may be predictive of increased healthcare utilization among African American older adults with DM. Research should test whether close monitoring of African American older adults with DM and poor SRH helps reduce their frequency of hospitalization and ED visits or not. Keywords Diabetes . Emergency department utilization . Healthcare use . Hospitalization . Blacks . African American . Older adults . Disparities . Diabetes . Chronic medical conditions
Introduction The US healthcare system faces a challenge to provide highquality services for the growing older population [1]. Hospital admissions and emergency department (ED) visits are two main forms of high-cost healthcare systems utilization. Older adults with diabetes mellitus (DM) and comorbid medical conditions (CMCs) are at an increased risk of hospitalization and are more likely to visit the ED [2–5]. At the same time, marginalized, underserved, low socioeconomic status (SES)
* Shervin Assari [email protected] 1
Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
2
Charles R. Drew University of Medicine and Science (CDU), Los Angeles, CA, USA
3
University of California, Los Angeles (UCLA), Los Angeles, CA, USA
and racial/ethnic minority populations who are more likely to have multiple CMCs are at an increased risk of hospitalization and ED visits [6]. Living in economically disadvantaged areas (low SES neighborhoods) is also associated with increased risk of hospitalization and with higher likelihood of visiting the ED [7]. Hospitalization and ED are among the most costly healthcare services [8]. Older adults, particularly those who belong to racial/et
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