December 1, 2014

Impact of diabetes on prolonged hospital stay among Native Hawaiians and other Pacific Islanders with ischemic stroke

Kazuma Nakagawa M.D., Megan A. Vento B.S., Marissa M. Ing M.S.W, Susan M. Asai M.S.N.

Hawai‘i Journal of Medicine & Public Health

Recent evidence suggests that minority groups have prolonged hospital stays after ischemic stroke. However, disparities in the hospital stay after ischemic stroke among Native Hawaiians and other Pacific Islanders (NHPI) have not been studied. A retrospective study on consecutive patients hospitalized for ischemic stroke at a single tertiary center in Honolulu between 2008 and 2010 was performed. Logistic regression analyses were performed to assess the independent predictors of prolonged hospital stay (hospitalization > 12 days after admission) after ischemic stroke. A total of 740 patients (whites 22%, Asians 53%, NHPI 21%, others 4%) hospitalized for ischemic stroke were studied. NHPI were significantly younger (59±14 years vs 72±13 years) and had significantly higher prevalence of female sex (51%vs 38%), no insurance (10%vs 4%), diabetes (53%vs 18%), hypertension (82%vs 62%), obesity (55%vs 20%) and prolonged hospital stay (20%vs 11%), and lower prevalence of residence outside of O‘ahu (12%vs 23%) compared to whites. Univariate analyses showed that NHPI were more likely to have prolonged hospital stay (OR 1.87, 95% CI: 1.01, 3.49) compared to whites. After adjusting for age, sex, race, risk factors, health insurance status, and geographical factor, diabetes (OR 1.76, 95% CI: 1.07, 2.89) was the only independent predictor of prolonged hospital stay. NHPI are associated with prolonged hospitalization after ischemic stroke. However, this effect was attenuated by the impact of diabetes. Further prospective studies are needed to understand the relationship between diabetes and prolonged hospital stay after ischemic stroke.

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