Race Differences in Gastrostomy Tube Placement After Stroke in Majority-White, Minority-Serving, and Racially Integrated US Hospitals

Abstract

We sought to determine individual and system contributions to race disparities in percutaneous endoscopic gastrostomy (PEG) tube placement after stroke. Ischemic stroke admissions were identified from the Nationwide Inpatient Sample between 2007 and 2011. Hospitals were categorized based on the percentage of ethnic/racial minority stroke patients (< 25% ethnic/racial minorities ["majority-white hospitals"], 25-50% ethnic/racial minorities ["racially integrated hospitals"], or > 50% ethnic/racial minorities ["minority-serving hospitals"]). Logistic regression was used to evaluate the association between ethnicity/race and PEG utilization within and between the different hospital strata. Among 246,825 stroke admissions, patients receiving care in minority-serving hospitals had higher odds of PEG compared to patients in majority-white hospitals, regardless of individual patient race (adjusted odds ratio [OR] 1.24, 95% CI 1.12-1.38). Ethnic/racial minorities had higher odds of PEG than whites in any hospital strata; however, this discrepancy was largest in majority-white hospitals (OR 1.62, 95% CI 1.48-1.76), and smallest in minority-serving hospitals (OR 1.22, 95% CI 1.11-1.33; p for interaction < 0.001). Ethnic/racial minority patients had similar odds of PEG in any hospital strata, while white patients had increasing odds of PEG in racially integrated and minority-serving compared to majority-white hospitals (OR 1.28, 95% CI 1.15-1.43 in racially integrated, and OR 1.39, 95% CI 1.23-1.57 in minority-serving, compared to majority-white hospitals, p for trend < 0.001). The likelihood of PEG after ischemic stroke was increased in minority-serving compared to majority-white hospitals. White patients had higher odds of PEG in minority-serving compared to majority-white hospitals, indicating a systemic difference in PEG placement across hospitals.

The geography of Medicare's hospital value‐based purchasing in relation to market demographics

“…While many studies of inequality in access to quality health care concentrate on the lower availability of health care, there is a growing body of literature reporting on the association between hospital quality and minority‐service hospital status across multiple health states and conditions. 4 , 5 , 8 , 10 , 13 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 Minority‐serving hospitals have also been shown to have lower scores for reported patient experience, despite findings that minority patients report better experiences overall. 12 , 50 , 51 A consistent finding has been that disparities in patient‐level health risks alone do not explain variation in quality between hospitals.…”

“…This reflects the idea that areas with higher percentages of racial and ethnic diversity tended to have lower‐performing hospitals, regardless of what specific racial or ethnic minority group predominated. While many studies of inequality in access to quality health care concentrate on the lower availability of health care, there is a growing body of literature reporting on the association between hospital quality and minority‐service hospital status across multiple health states and conditions 4,5,8,10,13,26–49 . Minority‐serving hospitals have also been shown to have lower scores for reported patient experience, despite findings that minority patients report better experiences overall 12,50,51 .…”

Trends Regarding Racial Disparities Among Malnourished Patients With Percutaneous Endoscopic Gastrostomy (PEG) Tubes

“…Previous studies have shown an elevated prevalence of poor nutrition in Black patients versus Caucasians [17]. Black patients had poorer nutritional intake (including fruits and vegetables), and older Black patients were at greater risk for malnutrition than their Caucasian counterparts [14,15,17]. Healthy food items are generally more expensive than less healthy choices, thereby limiting their availability to low-income populations [18].…”

“…Therefore, adequately managing malnutrition via interventions such as feeding tube placement is critical in improving outcomes. However, rates of PEG placement, and its risks, have been shown to differ among patients of different races and household incomes who have suffered a cerebrovascular accident, a major indication for the procedure [13,14]. Our goal is to determine if similar race-based differences exist in the identification of malnutrition in patients who have undergone PEG placement.…”