Preventable hospitalizations for hypertension: establishing a baseline for monitoring racial differences in rates

Abstract

Introduction: Preventable hospitalization for hypertension is an ambulatory care-sensitive condition believed to indicate the failure of outpatient and public health systems to prevent and control hypertension. Blacks have higher rates of such hospitalizations than whites. The 2010 Patient Protection and Affordable Care Act (PPACA) seeks to implement higher quality health care, which may help close the racial gap in these rates. The objective of this study was to analyze pre-PPACA baseline rates of preventable hypertension hospitalizations in the United States and racial differences over time.

Methods: We used data from the 1995-2010 National Hospital Discharge Survey, a stratified, probability-designed survey representing approximately 1% of hospitalizations in the United States. Rates were calculated using specifications published by the Agency for Healthcare Research and Quality requiring census data as denominators for the rates. We combined at least 3 years of data to obtain more precise estimates and conducted a trend analysis by using rates calculated for each of the resulting 5 periods.

Results: For both sexes, all age groups, and each period, blacks had higher crude rates than whites. Age- and sex-standardized rates confirmed this finding (eg, 2007-2010: blacks, 334 per 100,000; whites, 97.4 per 100,000). Rates were generally flat over time; however, white women aged 65 or older showed increasing rates.

Conclusion: Using national data, we confirmed higher rates of preventable hypertension hospitalizations for blacks, showing little improvement in disparities over time. This pre-PPACA baseline for blacks and whites allows for ongoing monitoring of preventable hospitalizations for hypertension.

Figure

Age- and sex-standardized preventable hospitalization rates for hypertension among adults in the United States, by race, National Hospital Discharge Survey, 1995–2010. Difference between whites and blacks was significant for all periods (calculated by using a z test). Error bars indicate confidence intervals. [Table: see text]