Examining Racial Differences in Access to Primary Care for People Living with Lupus: Use of Ambulatory Care Sensitive Conditions to Measure Access.

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  • Additional Information
    • Source:
      Publisher: Ethnicity & Disease, Inc Country of Publication: United States NLM ID: 9109034 Publication Model: eCollection Cited Medium: Internet ISSN: 1945-0826 (Electronic) Linking ISSN: 1049510X NLM ISO Abbreviation: Ethn Dis Subsets: MEDLINE
    • Publication Information:
      Publication: [Owings Mill, MD] : Ethnicity & Disease, Inc.
      Original Publication: [Atlanta, GA : International Society on Hypertension in Blacks], c1991-
    • Subject Terms:
      Health Services Accessibility* ; Primary Health Care*; Hospitalization/*statistics & numerical data ; Lupus Erythematosus, Systemic/*therapy ; Minority Groups/*statistics & numerical data; Adolescent ; Adult ; Aged ; Ambulatory Care ; Child ; Child, Preschool ; Cross-Sectional Studies ; Female ; Florida ; Humans ; Infant ; Infant, Newborn ; Male ; Medicaid/statistics & numerical data ; Medicare/statistics & numerical data ; Middle Aged ; North Carolina ; Race Factors ; South Carolina ; United States ; White People/statistics & numerical data ; Young Adult
    • Abstract:
      Background: People living with lupus may experience poor access to primary care and delayed specialty care.
      Purpose: To identify characteristics that lead to increased odds of poor access to primary care for minorities hospitalized with lupus.
      Methods: Cross-sectional design with 2011-2012 hospitalization data from South Carolina, North Carolina, and Florida. We used ICD-9 codes to identify lupus hospitalizations. Ambulatory care sensitive conditions were used to identify preventable lupus hospitalizations and measure access to primary care. Logistic regression was used to estimate the odds ratio for the association between predictors and having poor access to primary care. Sensitivity analysis excluded patients aged >65 years.
      Results: There were 23,154 total lupus hospitalizations, and 2,094 (9.04%) were preventable. An adjusted model showed minorities aged ≥65 years (OR 2.501, CI 1.501, 4.169), minorities aged 40-64 years (OR 2.248, CI: 1.394, 3.627), minorities with Medicare insurance (OR 1.669, CI:1.353,2.059) and minorities with Medicaid (OR 1.662,CI:1.321, 2.092) had the highest odds for a preventable lupus hospitalization. Minorities with Medicare had significantly higher odds for ≥3 hospital days (OR 1.275, CI: 1.149, 1.415). Whites with Medicare (OR 1.291, CI: 1.164, 1.432) had the highest odds for ≥3 days.
      Conclusions: Our data show that middle-aged minorities living with lupus and on public health insurance have a higher likelihood of poor access to primary care. Health care workers and policymakers should develop plans to identify patients, explore issues affecting access, and place patients with a community health worker or social worker to promote better access to primary care.
      Competing Interests: Competing Interests: None declared.
      (Copyright © 2020, Ethnicity & Disease, Inc.)
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    • Grant Information:
      K24 AR068406 United States AR NIAMS NIH HHS; P30 AR072582 United States AR NIAMS NIH HHS; T32 AR050958 United States AR NIAMS NIH HHS
    • Contributed Indexing:
      Keywords: Access to Primary Care; Hospitalizations; Systemic Lupus Erythematosus
    • Publication Date:
      Date Created: 20200929 Date Completed: 20210421 Latest Revision: 20240517
    • Publication Date:
      20240517
    • Accession Number:
      PMC7518530
    • Accession Number:
      10.18865/ed.30.4.611
    • Accession Number:
      32989361