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Patterns of Hospital Admissions and Emergency
Room Visits Among Patients with Scleroderma in South Carolina, USA
PAUL J. NIETERT and RICHARD M. SILVER
ABSTRACT. Objective. Little research has examined patterns of hospitalization and use of emergency rooms (ER) among patients with systemic sclerosis (SSc). We compared the incidence of hospitalizations and ER visits across 3 race groups (non-Hispanic white, non-Hispanic black, other) and determined predictors of referral to the Medical University of South Carolina (MUSC), a major referral center for patients with SSc residing in the southeastern United States. Methods. Data were obtained on all South Carolina hospitalizations (1996–2000) for patients who were ever hospitalized for a diagnosis of SSc during that time period. Hospitalization and ER incidence rates were determined in conjunction with corresponding population sizes obtained from the 2000 US Census, and rates were compared across race, sex, and age groups using Poisson regression models. Logistic regression was used to determine predictors of being treated at MUSC. Results. The hospitalization incidence rate was significantly (p < 0.05) higher among blacks compared to whites (rate ratio 1.66; 95% confidence interval 1.41, 1.96), as was the ER incidence rate (rate ratio 1.78; 95% CI 1.50, 2.11). Even after adjusting for sex, age, median household income, primary insurance claim payor, county, and comorbidity, blacks were 60% less likely (p < 0.05) than whites to receive inpatient treatment at MUSC. Similar results were observed when comparing other non-whites to whites. Conclusion. The increased hospitalizations and ER visits among non-whites provide additional evidence of greater disease burden among these population groups. Despite this increased burden, non-whites are less likely to receive care at a major SSc referral center. (J Rheumatol 2003;30:1238-43) Key Indexing Terms:
SYSTEMIC SCLERODERMA
From the Center for Health Care Research and Department of Medicine; and the Division of Rheumatology and Immunology and Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA. Supported in part by the Excellence Initiative to Eliminate Health Disparities in South Carolina, Grant 1 P01-HS10871-01, Agency for Healthcare Research and Quality, Rockville, MD, USA. P.J. Nietert, PhD, Assistant Professor, Center for Health Care Research; R.M. Silver, MD, Professor, Division of Rheumatology and Immunology. Address reprint requests to Dr. P.J. Nietert, Center for Health Care Research, Medical University of South Carolina, 135 Cannon Street, Suite 403, PO Box 250837, Charleston, SC 29425. E-mail: nieterpj@musc.edu Submitted August 14, 2002; revision accepted November 28, 2002. |