• Karen E Joynt, E John Orav, and Ashish K Jha.
• Department of Health Policy and Management, Harvard School of Public Health, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA. kjoynt@partners.org
• JAMA. 2011 Feb 16; 305 (7): 675681675-81.

ContextUnderstanding whether and why there are racial disparities in readmissions has implications for efforts to reduce readmissions.ObjectiveTo determine whether black patients have higher odds of readmission than white patients and whether these disparities are related to where black patients receive care.DesignUsing national Medicare data, we examined 30-day readmissions after hospitalization for acute myocardial infarction (MI), congestive heart failure (CHF), and pneumonia. We categorized hospitals in the top decile of proportion of black patients as minority-serving. We determined the odds of readmission for black patients compared with white patients at minority-serving vs non-minority-serving hospitals.Setting And ParticipantsMedicare Provider Analysis Review files of more than 3.1 million Medicare fee-for-service recipients who were discharged from US hospitals in 2006-2008.Main Outcome MeasureRisk-adjusted odds of 30-day readmission.ResultsOverall, black patients had higher readmission rates than white patients (24.8% vs 22.6%, odds ratio [OR], 1.13; 95% confidence interval [CI], 1.11-1.14; P < .001); patients from minority-serving hospitals had higher readmission rates than those from non-minority-serving hospitals (25.5% vs 22.0%, OR, 1.23; 95% CI, 1.20-1.27; P < .001). Among patients with acute MI and using white patients from non-minority-serving hospitals as the reference group (readmission rate 20.9%), black patients from minority-serving hospitals had the highest readmission rate (26.4%; OR, 1.35; 95% CI, 1.28-1.42), while white patients from minority-serving hospitals had a 24.6% readmission rate (OR, 1.23; 95% CI, 1.18-1.29) and black patients from non-minority-serving hospitals had a 23.3% readmission rate (OR, 1.20; 95% CI, 1.16-1.23; P < .001 for each); patterns were similar for CHF and pneumonia. The results were unchanged after adjusting for hospital characteristics including markers of caring for poor patients.ConclusionAmong elderly Medicare recipients, black patients were more likely to be readmitted after hospitalization for 3 common conditions, a gap that was related to both race and to the site where care was received.

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