To determine whether the hospital stays are longer and charges within a given diagnosis-related group (DRG) are higher for poor patients, we examined patterns of care for patients hospitalized at the Brigham and Women's Hospital for connective-tissue disorders (DRGs 240 and 241) from 1981 to 1985. The socioeconomic characteristics of 402 patients were determined through interviews, and the severity of their illness was measured by means of a standard scale of function--the Instrumental Activities of Daily Living (IADL) scale. After excluding outliers and adjusting for DRG, we found that hospital stays were significantly longer for subgroups of patients of lower socioeconomic status, whether this was defined by occupation, education, or income (P less than 0.05 for all three). Patients of low socioeconomic status also had higher total hospital charges, although the differences were not statistically significant. The differences between patients of low socioeconomic status and those of high socioeconomic status were as great as 25 percent for length of stay and 16 percent for charges. These trends persisted after we adjusted for patients' age and sex, the severity of illness, the year of discharge, the doctor's specialty, whether the patient had a regular doctor, and whether the patient lived alone. Our results suggest that for at least some conditions, hospital care for poor patients entails longer stays and probably requires the use of more resources.
The effects of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) on breast-feeding behavior have been sometimes found inadequate. The determinants of breast-feeding initiation and duration among WIC participants and nonparticipants were modeled by using retrospective cross-sectional data from the 1988 National Maternal and Infant Health Survey. This study corrects for self-selection bias as far as the data allow, in addition to controlling for parents' ages, education, race, and family income. Findings suggest that prenatal WIC participation, combined with breast-feeding advice, significantly increases the initiation of breast-feeding but does not affect duration. The exact nature of effective breast-feeding advice given prenatally at WIC clinics is unclear and warrants further research.
To the Editor.—
The study "Recent Declines in Breast-Feeding in the United States, 1984-1989" by Ryan et al1 recently was brought to our attention because it reports a negative statistical association between participation in the United States Department of Agriculture's Special Supplemental Food Program for Women, Infants and Children (WIC) and the initiation and duration of breast-feeding.
WIC staff at all levels have been working actively to promote breast-feeding in the Program2-4 for many years, and they certainly would be concerned about a negative impact of the Program on breast-feeding.
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