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Quiñones AR, McAvay GJ, Peak KD, Vander Wyk B, Allore HG. The Contribution of Chronic Conditions to Hospitalization, Skilled Nursing Facility Admission, and Death: Variation by Race. Am J Epidemiol 2022; 191:2014-2025. [PMID: 35932162 PMCID: PMC10144669 DOI: 10.1093/aje/kwac143] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/24/2022] [Accepted: 08/01/2022] [Indexed: 02/01/2023] Open
Abstract
Multimorbidity (≥2 chronic conditions) is a common and important marker of aging. To better understand racial differences in multimorbidity burden and associations with important health-related outcomes, we assessed differences in the contribution of chronic conditions to hospitalization, skilled nursing facility admission, and mortality among non-Hispanic Black and non-Hispanic White older adults in the United States. We used data from a nationally representative study, the National Health and Aging Trends Study, linked to Medicare claims from 2011-2015 (n = 4,871 respondents). This analysis improved upon prior research by identifying the absolute contributions of chronic conditions using a longitudinal extension of the average attributable fraction for Black and White Medicare beneficiaries. We found that cardiovascular conditions were the greatest contributors to outcomes among White respondents, while the greatest contributor to outcomes for Black respondents was renal morbidity. This study provides important insights into racial differences in the contributions of chronic conditions to costly health-care utilization and mortality, and it prompts policy-makers to champion delivery reforms that will expand access to preventive and ongoing care for diverse Medicare beneficiaries.
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Affiliation(s)
- Ana R Quiñones
- Correspondence to Dr. Ana R. Quiñones, Department of Family Medicine, School of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239 (e-mail: )
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Simon-Kumar R, Lewycka S, Clark TC, Fleming T, Peiris-John R. Flexible resources and experiences of racism among a multi-ethnic adolescent population in Aotearoa, New Zealand: an intersectional analysis of health and socioeconomic inequities using survey data. Lancet 2022; 400:1130-1143. [PMID: 36183729 DOI: 10.1016/s0140-6736(22)01537-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 07/24/2022] [Accepted: 08/05/2022] [Indexed: 12/20/2022]
Abstract
BACKGROUND As societies become increasingly diverse, understanding the complex nature of racism for multiple ethnic, social, and economic identities of minority youth is required. Here we explore the experience of racism between and among privileged majority adolescent groups and targeted minority (Indigenous and ethnic) adolescents in New Zealand. Using the concept of structural and embodiment flexible resources, which act as risk and protective factors, we examine the social and health effects on minority youth. METHODS In this intersectional analysis, we use self-reported data from the Youth2000 survey series administered in 2001, 2007, 2012, and 2019 to large, representative samples of students from mainstream state and private schools in the Auckland, Tai Tokerau, and Waikato regions of New Zealand. Students were in school years 9-13 and mostly aged 13-17 years. Ethnic or migrant group, income level of country of origin, and migrant generation were used as measures of structural resources and perceived ethnicity as a measure of embodiment resource. Racism and its effects were measured as socioeconomic inequities (household, neighbourhood, and school-level deprivation); interpersonal discrimination (unfair treatment, bullying, and safety); and health inequities (forgone health care, symptoms of depression, and attempted suicide). We used generalised linear models to explore variations in economic, interpersonal, and health outcomes for Indigenous and migrant youth, adjusting for mediating effects of household deprivation and measures of flexible resources (migration generation, income level of country of origin, and perceived ethnicity). FINDINGS We collected data from a total of 20 410 adolescents from the four survey waves between 2001 and 2019. Participants had a median age of 15 years (IQR 14-16). Socioeconomic, interpersonal, and health inequities varied with access to flexible resources among Māori and racialised migrant youth. Māori and racialised migrants from low-income and middle-income countries in particular experienced high levels of socioeconomic inequities. Racialised migrant youth experienced persistent socioeconomic inequities extending over three generations, especially Pasifika migrant adolescents. Minorities perceived as White experienced less discrimination and had more advantages than visibly racialised groups. Regression models showed that embodiment resources, and to a lesser extent structural resources, mediated, but did not eliminate ethnic disparities in socioeconomic status and interpersonal discrimination; these resources did not strongly mediate ethnic disparities in health. Trend analyses indicate consistency in these patterns with ethnicity-based inequities persisting or increasing over time. INTERPRETATION Indigenous and ethnic minority experiences of racism are heterogeneous. Structural flexible resources (wealth) and, more substantially, embodiment flexible resources (perceived Whiteness) mitigate individual experiences of racism. In multi-ethnic western societies, anti-racist interventions and policies must address both structural deprivation and associated intergenerational mobility and colourism (ie, implicit and explicit bias against non-White youth). FUNDING Health Research Council of New Zealand.
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Affiliation(s)
- Rachel Simon-Kumar
- Centre for Asian and Ethnic Minority Health Research and Evaluation, School of Population Health, Faculty of Medical Health Sciences, Waipapa Taumata Rau/University of Auckland, Auckland, New Zealand
| | - Sonia Lewycka
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Terryann C Clark
- School of Nursing, Faculty of Medical Health Sciences, Waipapa Taumata Rau/University of Auckland, Auckland, New Zealand
| | - Theresa Fleming
- School of Health, Te Herenga Waka Victoria/University of Wellington, Wellington, New Zealand
| | - Roshini Peiris-John
- Centre for Asian and Ethnic Minority Health Research and Evaluation, School of Population Health, Faculty of Medical Health Sciences, Waipapa Taumata Rau/University of Auckland, Auckland, New Zealand.
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Richmond TS, Wiebe DJ, Reilly PM, Rich J, Shults J, Kassam-Adams N. Contributors to Postinjury Mental Health in Urban Black Men With Serious Injuries. JAMA Surg 2020; 154:836-843. [PMID: 31166596 DOI: 10.1001/jamasurg.2019.1622] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Physical injury is associated with postinjury mental health problems, which typically increase disability, cost, recidivism, and self-medication for symptoms. Objective To determine risk and protective factors across the life span that contribute to depression and posttraumatic stress symptom severity at 3 months after hospital discharge. Design, Setting, and Participants This prospective cohort study used a 3-month postdischarge follow-up of patients who had been treated at an urban, level 1 trauma center in the Northeastern United States. Men with injuries who were hospitalized, self-identified as black, were 18 years or older, and resided in the Philadelphia, Pennsylvania, region were eligible and consecutively enrolled. Those who were experiencing a cognitive dysfunction or psychotic disorder, hospitalized because of attempted suicide, or receiving current treatment for depression or posttraumatic stress disorder (PTSD) were excluded. Data were collected from January 2013 to October 2017. Data analysis took place from January 2018 to August 2018. Exposures A serious injury requiring hospitalization; adverse childhood experiences, childhood neighborhood disadvantage, and preinjury physical and mental health; and emotional resources, injury intent, and acute stress responses. Main Outcomes and Measures Depression and PTSD symptom severity were assessed with the Quick Inventory of Depressive Symptoms-Self-report and the PTSD Check List-5. The a priori hypothesis was that risk and protective factors are associated with depression and PTSD symptom severity. The analytic approach was structural equation modeling. Results A total of 623 black men were enrolled. Of these, 502 participants (80.6%) were retained at 3-month follow-up. Their mean (SD) age was 35.6 (14.9) years; 346 (55.5%) had experienced intentional injuries, and the median (range) Injury Severity Score was 9 (1-45). Of the 500 participants with complete primary outcome data, 225 (45.0%) met the cut point criteria for mental health diagnoses at 3 months. For both mental health outcomes, the models fit the data well (depression: root mean square error of approximation [RMSEA], 0.044; comparative fit index [CFI], 0.93; PTSD: RMSEA = 0.045; CFI = 0.93), and all hypothesized paths were significant and in the hypothesized direction. Outcomes were associated with poor preinjury health (standardized weights: depression, 0.28; P < .001; PTSD, 0.17; P = .02), acute psychological reactions (depression, 0.34; PTSD, 0.38; both P < .001), and intentional injury (depression, 0.16; PTSD, 0.24; both P < .001). Acute psychological reactions were associated with childhood adversity (depression, 0.33; PTSD, 0.36; both P < .001). A history of prior mental health challenges (depression, 0.70; PTSD, 0.70; both P < .001) and psychological or emotional health resources (depression, -0.22; PTSD, -0.23; both P = .003) affected poor preinjury health, which was in turn associated with acute psychological reaction (depression, 0.44; PTSD, 0.42; both P < .001). Conclusions and Relevance The intersection of prior trauma and adversity, prior exposure to neighborhood disadvantage, and poorer preinjury health and functioning are important, even in the midst of acute medical care for traumatic injury. These results support the importance of trauma-informed health care and focused assessment to identified patients with injuries who are at highest risk for poor postinjury mental health outcomes.
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Affiliation(s)
- Therese S Richmond
- Biobehavioral Health Sciences Department, School of Nursing, University of Pennsylvania, Philadelphia.,Penn Injury Science Center, University of Pennsylvania, Philadelphia
| | - Douglas J Wiebe
- Penn Injury Science Center, University of Pennsylvania, Philadelphia.,Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Patrick M Reilly
- Penn Injury Science Center, University of Pennsylvania, Philadelphia.,Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - John Rich
- Department of Health Policy & Management, School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Justine Shults
- Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Nancy Kassam-Adams
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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McFarland MJ. Poverty and Problem Behaviors across the Early Life Course: The Role of Sensitive Period Exposure. POPULATION RESEARCH AND POLICY REVIEW 2017. [DOI: 10.1007/s11113-017-9442-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Ferraro KF, Kemp BR, Williams MM. Diverse Aging and Health Inequality by Race and Ethnicity. Innov Aging 2017; 1:igx002. [PMID: 29795805 PMCID: PMC5954610 DOI: 10.1093/geroni/igx002] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 03/09/2017] [Indexed: 12/14/2022] Open
Abstract
Although gerontologists have long embraced the concept of heterogeneity in theories and models of aging, recent research reveals the importance of racial and ethnic diversity on life course processes leading to health inequality. This article examines research on health inequality by race and ethnicity and identifies theoretical and methodological innovations that are transforming the study of health disparities. Drawing from cumulative inequality theory, we propose greater use of life course analysis, more attention to variability within racial and ethnic groups, and better integration of environmental context into the study of accumulation processes leading to health disparities.
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Affiliation(s)
- Kenneth F Ferraro
- Department of Sociology, Purdue University, West Lafayette, Indiana.,Center on Aging and the Life Course, Purdue University, West Lafayette, Indiana
| | - Blakelee R Kemp
- Department of Sociology, Purdue University, West Lafayette, Indiana.,Center on Aging and the Life Course, Purdue University, West Lafayette, Indiana
| | - Monica M Williams
- Department of Sociology, Purdue University, West Lafayette, Indiana.,Center on Aging and the Life Course, Purdue University, West Lafayette, Indiana
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Shippee TP, Henning-Smith C, Rhee TG, Held RN, Kane RL. Racial Differences in Minnesota Nursing Home Residents' Quality of Life: The Importance of Looking Beyond Individual Predictors. J Aging Health 2015; 28:199-224. [PMID: 26112065 DOI: 10.1177/0898264315589576] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES The aim of this study is to investigate racial differences in nursing home (NH) residents' quality of life (QOL) at the resident and facility levels. METHOD We used hierarchical linear modeling to identify significant resident- and facility-level predictors for racial differences in six resident-reported QOL domains. Data came from the following: (a) resident-reported QOL (n = 10,929), (b) the Minimum Data Set, and (c) facility-level characteristics from the Minnesota Department of Human Services (n = 376). RESULTS White residents reported higher QOL in five of six domains, but in full models, individual-level racial differences remained only for food enjoyment. On the facility level, higher percentage of White residents was associated with better scores in three domains, even after adjusting for all characteristics. DISCUSSION Racial differences in QOL exist on individual and aggregate levels. Individual differences are mainly explained by health status. The finding that facility racial composition predicts QOL more than individual race underscores the importance of examining NH structural characteristics and practices.
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Affiliation(s)
| | | | | | - Robert N Held
- Minnesota Department of Human Services, Minneapolis, USA
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Abstract
OBJECTIVE To summarize the current literature on racial and gender disparities in critical care and the mechanisms underlying these disparities in the course of acute critical illness. DATA SOURCES MEDLINE search on the published literature addressing racial, ethnic, or gender disparities in acute critical illness, such as sepsis, acute lung injury, pneumonia, venous thromboembolism, and cardiac arrest. STUDY SELECTION Clinical studies that evaluated general critically ill patient populations in the United States as well as specific critical care conditions were reviewed with a focus on studies evaluating factors and contributors to health disparities. DATA EXTRACTION Study findings are presented according to their association with the prevalence, clinical presentation, management, and outcomes in acute critical illness. DATA SYNTHESIS This review presents potential contributors for racial and gender disparities related to genetic susceptibility, comorbidities, preventive health services, socioeconomic factors, cultural differences, and access to care. The data are organized along the course of acute critical illness. CONCLUSIONS The literature to date shows that disparities in critical care are most likely multifactorial involving individual, community, and hospital-level factors at several points in the continuum of acute critical illness. The data presented identify potential targets as interventions to reduce disparities in critical care and future avenues for research.
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Affiliation(s)
- Graciela J Soto
- 1Division of Critical Care Medicine, Department of Medicine, Jay B. Langner Critical Care Service, Montefiore Medical Center, Bronx, NY. 2Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Emory University, Grady Memorial Hospital, Atlanta, GA. 3Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
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Lagomasino IT, Stockdale SE, Miranda J. Racial-ethnic composition of provider practices and disparities in treatment of depression and anxiety, 2003-2007. Psychiatr Serv 2011; 62:1019-25. [PMID: 21885579 PMCID: PMC4805374 DOI: 10.1176/appi.ps.62.9.1019] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study explored whether racial and ethnic disparities in the treatment of depression and anxiety are associated with provider-level factors. METHODS This study analyzed 58,826 office-based adult outpatient visits to primary care physicians and psychiatrists. Data were from the National Ambulatory Medical Care Survey, 2003-2007. Outcomes included counseling and referral for counseling, antidepressant prescription, and any care for depression or anxiety. The analyses of treatment outcomes were not limited to visits with a depression or anxiety diagnosis. RESULTS Compared with visits to primary care physicians by whites, such visits by blacks and Hispanics were less likely to result in antidepressant prescription or in any care for depression or anxiety; primary care visits by Hispanics were also less likely to result in counseling. Compared with visits to psychiatrists by whites, such visits by blacks were less likely to result in an antidepressant prescription. The majority of visits to both primary care physicians and psychiatrists by blacks and Hispanics were to practices serving a high percentage of nonwhite patients. However, racial and ethnic disparities in care that were especially evident in primary care settings persisted after the analyses controlled for whether visits were to settings with a high or low percentage of nonwhite patients. CONCLUSIONS Disparities in care for depression and anxiety in primary care continue and are not fully accounted for by less care being provided in settings that nonwhites frequent. Physician bias, resource issues, and patient factors may all play a role in the diagnosis and treatment of depression and anxiety.
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Affiliation(s)
- Isabel T. Lagomasino
- Department of Psychiatry, Keck School of Medicine, University of Southern California, Los Angeles
| | - Susan E. Stockdale
- Center for Health Services and Society, University of California, Los Angeles (UCLA), 10920 Wilshire Blvd., Suite 300, Los Angeles, CA 90291 (). She is also with the Center for the Study of Healthcare Provider Behavior, Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles
| | - Jeanne Miranda
- Department of Psychiatry and Biobehavioral Sciences, UCLA
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Shippee TP, Ferraro KF, Thorpe RJ. Racial disparity in access to cardiac intensive care over 20 years. ETHNICITY & HEALTH 2011; 16:145-65. [PMID: 21318914 PMCID: PMC3144756 DOI: 10.1080/13557858.2010.544292] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVES The purposes of this article are: (1) to systematically examine racial disparities in access to and use of cardiac care units (CCUs) in acute-care hospitals; and (2) to assess racial differences in post-hospital mortality following CCU stays. DESIGN Data from the National Health and Nutrition Examination Survey I: Epidemiologic Follow-up Study of adults aged 25 and older at baseline are analyzed to track CCU use and survival after hospitalization over 20 years (N=4227). Estimates are derived from Cox proportional-hazards models with time-dependent covariates and from negative binomial and tobit regression analyses. All analyses adjust for disease severity, hospitalization history, and resources. RESULTS Black adults were less likely than White adults to be admitted to a CCU, even after adjusting for morbidities, health behaviors, previous hospitalization experience, and socioeconomic status. Comparing Black and White adults admitted to CCUs, Black adults spent fewer days and a smaller proportion of their hospital stay in CCUs. Black adults also had fewer CCU stays over the 20-year period and were more likely to die post-discharge, although the latter result was mediated by disease severity. CONCLUSIONS Higher morbidity, lower admission rates, fewer stays, and shorter stays reveal that racial inequality is far-reaching and exists even in such highly-specialized units as CCUs. The fact that Black individuals' greater post-discharge mortality was mediated by disease severity illustrated that even among high-risk individuals, the accumulation of morbidity factors (beyond cardiac problems) is a salient concern. Overall findings demonstrate that the accumulation of disadvantage for Black adults is not confined to discretionary medical measures, but also exists in critical care for serious health problems.
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Affiliation(s)
- Tetyana P Shippee
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA.
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Pearlin LI. The life course and the stress process: some conceptual comparisons. J Gerontol B Psychol Sci Soc Sci 2009; 65B:207-15. [PMID: 20022925 DOI: 10.1093/geronb/gbp106] [Citation(s) in RCA: 205] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This paper compares the meanings and applications of concepts relevant to both the life course and the stress process frameworks. Some of these concepts bear the same labels but serve quite different scholarly agendas. Other concepts have different labels but have closely related applications. The purpose of this kind of comparative analysis is to help both fields clarify the conceptual tools needed to advance their scholarly goals.
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Han E, Truesdale KP, Taber DR, Cai J, Juhaeri J, Stevens J. Impact of overweight and obesity on hospitalization: race and gender differences. Int J Obes (Lond) 2009; 33:249-56. [PMID: 19153585 PMCID: PMC3008347 DOI: 10.1038/ijo.2008.193] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To examine associations between weight status and number of all-cause and cause-specific hospitalizations overall, and by race and gender. DESIGN Longitudinal cohort study. SUBJECTS White and black adults (n=15 355) from the Atherosclerosis Risk in Communities Study who were normal weight (body mass index: >or=18.5 to <25.0 kg m(-2); n=4997), overweight (>or=25.0 to <30.0 kg m(-2); n=6100), or obese (>or=30.0 kg m(-2); n=4258) at baseline. MEASUREMENTS Information on hospitalizations was collected using community and cohort surveillance methods. Negative binomial models adjusted for race, gender, field center, age, physical activity, education level, smoking status, alcoholic beverage consumption and health insurance at baseline. Adjusted numbers of hospitalizations were calculated after setting covariates to the mean value (for continuous variables) or to the average distribution (for categorical variables) observed in the entire cohort and are expressed as the number of hospitalizations per 1000 adults followed over a period of 13 years. RESULTS The covariate-adjusted average number of all-cause hospitalizations was 1316 per 1000 normal weight, 1543 per 1000 overweight and 2025 per 1000 obese. Normal weight women had significantly fewer hospitalizations than normal weight men (1173 versus 1515 per 1000), but the increase associated with being obese on the number of all-cause hospitalizations was larger in women than men (791 versus 589 per 1000). There was no significant difference detected between the number of hospitalizations in normal weight whites and blacks, and the increase in hospitalizations with overweight or obesity was also not different. Effects of weight status on several primary causes of hospitalization differed by gender and race group. CONCLUSION Our work suggests that obesity prevention may reduce hospitalizations, a major component of rising healthcare costs. The impact of successful obesity prevention is likely to be larger in women than in men, and similar in blacks and whites.
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Affiliation(s)
- E Han
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - KP Truesdale
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - DR Taber
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - J Cai
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - J Juhaeri
- Global Pharmacovigilance and Epidemiology, Sanofi-Aventis, Bridgewater, NJ, USA
| | - J Stevens
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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