Off Balance

Inpatient care greater and pricier for Black and Hispanic patients living with HS 

According to a recent study, Black and Hispanic patients with hidradenitis suppurativa (HS) experience more and costlier hospitalization procedures compared to White patients with HS. In addition, Black patients with HS statistically face a longer length of stay per hospital procedure.

These findings, after creating multivariable linear regression models that adjusted for age, sex, and insurance, also highlighted the fact that the hospitalized Black and Hispanic patients with HS were younger than White patients with HS.

To determine these racial/ethnic disparities, a Johns Hopkins Medical School research team analyzed data from the 2012-2017 National Inpatient Sample (NIS). The researchers identified 8,040 HS hospital admissions for White patients, 16,490 Black patients, and 2,405 for Hispanic patients during the sample’s 5-year period.

Investigation conclusions were delivered in a poster presentation during the 2021 Skin of Color Society symposium. The poster is titled Racial and Ethnic Disparities in Inpatient Healthcare Utilization for Hidradenitis Suppurativa: Analysis of the 2012-2017 National Inpatient Sample.

Filling in the Gaps

The study’s objective was to answer questions still unresolved by previous research, explained Nishadh Sutaria, BS, a medical student at Tufts University, Boston, in this poster presentation. “While prior studies have shown racial and ethnic disparities in HS with Black and Hispanic patients affected more, there are limited data on how these disparities translate to the inpatient setting,” Dr. Sutaria explained. “We hypothesized that similar trends would exist in the inpatient setting, with Blacks and Hispanics affected disproportionately.”

After confirming their hypothesis, the research team concluded that the observed patterns of racial and ethnic disparities “may be due to increased disease severity and greater difficulty of HS management” among Black and Hispanic patients with HS.

However, Dr. Sutaria added, “These findings may also reflect inequalities in access to dermatologists, resulting in racial and ethnic minorities using inpatient services in lieu of outpatient care. Without appropriate access, minorities may also be utilizing emergency and inpatient services as their primary source of healthcare.”

Identifying a Path to the Facts

Beginning with the 2012-2017 NIS, hospital admissions for HS were identified using the International Classification of Diseases, Tenth Revision, Clinical Modification code L73.2. All comparisons were made between White, Black, and Hispanic patients as the inpatient prevalence of HS was highest in these groups. Continuous and categorical variables were compared using Student’s I-test and x2, respectively. Multivariable linear regression models were constructed to determine the impact of race/ethnicity (independent variable) on number of procedures, length of stay, and cost of care (dependent variables), adjusting for age, sex, and insurance type (covariates).

These models showed that Black race correlated with more hospital procedures (13 0.26; 95% Cl: 0.12 – 0.40, P<0.001 ), longer length of hospital stay (13 0.98; 95% Cl: 0.49 -1 .48, P<0.001), and higher cost of care (13 $7,728; 95% Cl: $2,921 – $12,536, P=0.002). Hispanic ethnicity correlated with more hospital procedures (13 0.28; 95%, Cl: 0.04 – 0.52, P=0.023) and higher cost of care (13 $14,655; 95% Cl: $6,266 – $23,043, P=0.001).

Simplifying the models’ results, Dr. Sutaria concluded, “Black patients with HS stayed inpatient almost a full day longer and accrued a charge of $8,000 more than white patients. Hispanic patients stayed about half a day longer and accrued a charge of almost $15,000 more than white patients.”

It’s a fact with far reaching implications, as the poster succinctly concludes: “Clinicians must be aware of these associations as these disparities impact not only the individual patient but healthcare systems overall.”