Economic and clinical disparities in hospitalized patients with type 2 diabetes

Purpose: To identify and describe economic and clinical relationships and trends associated with selected access, equity, and outcome characteristics of a large inpatient population with Type 2 diabetes. Design: Longitudinal, descriptive cross-sectional study with secondary analyses of data about 101,944 patients in hospitals in the United States (US), 40 years of age and older with a primary diagnosis of Type 2 diabetes from the Health Care Cost and Utilization Project (HCUP-3) database for 1994-1997. Methods: Descriptive analysis, hierarchical, random-effects regression modeling, and contrasts between covariate-adjusted means. Hospital charge data were highly skewed in a positive direction requiring a logarithmic transformation. Variables for the study included both hospital and patient characteristics. Findings: Significant racial and sex disparities were found in health care access, equity, and outcomes, with equity characteristics showing alarming disparities in types of procedures (amputations and peripheral vascular bypass grafts) performed, lengths of stay, and dispositions. Conclusions: Disparities in health care access, equity, and outcomes continue to exist on the basis of sex, ethnicity, and age as well as the type and location of the hospital. Access and equity are values that, despite rhetoric in relation to health care utilization, have not been systematically attained.