Impact of disparities on potentially preventable hospitalization for diabetes: a systematic review

Background Diabetes is one of the most common chronic diseases in nearly all countries, and the number of patients with diabetes is steadlily increasing. Potentially preventable hospitalizations (PPH) are hospital admissions for Ambulatory care-sensitive conditions that should not required in-hospital treatment if timely and appropriate ambulatory care is provided. Prior studies suggests that inequalities have an influence on the rate of PPH for diabetes. A systematic review was performed to assess the impact of disparities on PPH for diabetes. Methods A systematic review of the literature by querying electronic databases and hand searching was carried out. The selected studies were assessed for methodological quality independently by two authors, according to a score based on 5 potential sources of bias (methods of allocation to study group, data analysis and presentation of results, presence of baseline differences between the groups, objectivity of the outcome, completeness of follow up). This systematic review analyses the association between avoidable hospitalization and disparities measured by different indicators. Results Literature review identified 14 relevant studies containing data for more than 1,370,000 admissions. The indicators of disparities used in these studies were gender, age, race/ ethnicity, income, education level. Around 71% of the studies reported the significant effect of ethnic minorities, in univariate analysis (4 studies) or multiple analysis (6 studies). Males had a higher risk of avoidable hospitalization in multiple analysis models applied in 5 studies (43%). Around 36% of studies reported a significant effect of lower income on PPH. A single study dealing with education level showed no significant association with PPH.Conclusions Disparities at potentially preventable hospitalization exist across a number of determinants for diabetes. Promoting equity in disease prevention and treatment should be a priority of any health care system.