Higher Inpatient Racial and Ethnic Diversity Is Associated with Better Outcomes in Hispanic and Native American Patients for Gastrointestinal Diseases

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Abstract
Evidence suggests that outcomes are poorer among patients from historically marginalized racial and ethnic backgrounds. The impact of patient racial and ethnic diversity on gastrointestinal outcomes is understudied. To investigate the impact of patient racial/ethnic diversity on gastrointestinal disease (GI) outcomes. Using the 2019 National Inpatient Sample (NIS), hospital inpatient racial/ethnic diversity was defined as the percentage of Hispanic or Native American discharges. We included gastrointestinal bleeding, inflammatory bowel diseases, gastrointestinal obstruction, cirrhosis, and alcohol-associated hepatitis. Logistic regression was used to predict outcomes [major complications (MCC), long length of stay, high total charges], controlling for age, gender, location, income quartile, hospital size, and region. Our cohort included 537,830 hospitalizations. In the unadjusted analyses, MCC rates were higher among Hispanic (24.8%) and Native American patients (30.4%), compared to Whites (18.3%). In adjusted analyses, compared to Whites, Hispanic [adjusted odds ratio (OR) 1.21, 95% Confidence Interval (CI) 1.15-1.28] and Native American patients [OR 1.25, (95% CI) 1.09-1.43] had higher MCC rates. As hospital Hispanic diversity increased, MCC for Hispanics improved [OR 0.93, (95% CI) 0.87-1.14] and were even better among Native American patients as their diversity increased [OR 0.83, (95% CI) 0.73-0.94] (Table 1). A similar trend was observed in the 2018 validation cohort. Increasing hospital inpatient Hispanic and Native American diversity is associated with better outcomes for these groups. Further research is needed on the impact cultural competence and linguistic concordance on gastrointestinal outcomes.

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