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Objective. We sought to determine the frequency and costs of hospitalization and to assess possible racial/ethnic disparities in a large cohort of low-income patients with diabetes who had received primary care at municipal health clinics. Methods. Administrative data from Philadelphia Health Care Centers were linked with discharge data from Pennsylvania hospitals for March 1993 through December 2001. We tested differences in hospitalization rates and mean hospital charges by age, gender, and race/ethnicity. Results. A total of 18800 patients with diabetes experienced 30528 hospital admissions, for a hospitalization rate of 0.35 per person-year. Rates rose with age and with the interaction of male gender and age. Rates for non-Hispanic Whites were higher than those for African Americans, whereas those for Hispanics, Asian Americans, and 'others' were lower. Patients who were hospitalized at least 5 times made up 10.5% of the study population and accounted for 64% of hospital admissions and hospital charges in this cohort. Conclusions. Hospitalization rates for this low-income cohort with access to primary care and pharmacy services were comparable to those of other diabetic patient populations, suggesting that reducing financial barriers to care may have benefited these patients. A subgroup of patients with multiple hospitalizations accounted for the majority of hospital admissions. (doi:10.2105/AJPH.2004.059600)

Abstract Objective To determine the value of maternal height and weight data on birth certificate records when estimating prevalence of overweight and obese adults at the neighborhood level. Research Design and Methods Regression analysis was used to determine how much variation in the percentage of the adult population with a body mass index (BMI) of ≥ 25 (based on survey data) could be accounted for by the percentage of mothers with BMI ≥ 25 (based on birth certificate data) -- alone and in combination with other sociodemographic characteristics of census tracts. Results Alone, the percentage of mothers with BMI ≥ 25 explained more than half (R2 = .52) of the variation in the percentage of all residents in census tracts with BMI ≥ 25; in combination with several measures of the sociodemographic characteristics of the census tracts, 75% ( R2 = 75.2) of the variation is explained. Conclusions Maternal height and weight data available from birth certificate records may be useful for identifying neighborhoods with relatively high or low prevalence of adult residents who are overweight or obese. This is especially true if used in combination with readily available census data.

Abstract Background We sought to determine the frequency and distribution of cardiovascular comorbidities in a large cohort of low-income patients with diabetes who had received primary care for diabetes at municipal health clinics. Methods Outpatient data from the Philadelphia Health Care Centers was linked with hospital discharge data from all Pennsylvania hospitals and death certificates. Results Among 10,095 primary care patients with diabetes, with a mean observation period of 4.6 years (2.8 after diabetes diagnosis), 2,693 (14.3%) were diagnosed with heart disease, including 270 (1.4%) with myocardial infarction and 912 (4.8%) with congestive heart failure. Cerebrovascular disease was diagnosed in 588 patients (3.1%). Over 77% of diabetic patients were diagnosed with hypertension. Incidence rates of new complications ranged from 0.6 per 100 person years for myocardial infarction to 26.5 per 100 person years for hypertension. Non-Hispanic whites had higher rates of myocardial infarction, and Hispanics and Asians had fewer comorbid conditions than African Americans and non-Hispanic whites. Conclusion Cardiovascular comorbidities were common both before and after diabetes diagnosis in this low-income cohort, but not substantially different from mixed-income managed care populations, perhaps as a consequence of access to primary care and pharmacy services.

AbstractBackgroundMethodsResultsConclusionsPhiladelphia’s opioid overdose crisis has reached unprecedented levels. However, overdose deaths involving non-opioids have also increased in recent years. As overdose deaths continue to increase, this study describes and compares the demographic characteristics, prescription drug histories, and exposure to potentially inappropriate prescribing practices (PIPPs), in the year before death of three groups of overdose decedents: (1) only opioid(s) detected in postmortem toxicology, (2) only non-opioid(s) detected, (3) both opioids and non-opioids co-detected [i.e. concomitant detections].Philadelphia Medical Examiner’s Office data on unintentional overdose deaths from July 1, 2017 to June 30, 2022, were matched to Pennsylvania Prescription Drug Monitoring Program data. Differences were assessed using chi-square analyses, z-tests of proportions, and a multinomial logistic regression.During the study period, 5,440 overdose deaths occurred in Philadelphia. Compared to the other two toxicology groups, a substantially larger proportion of non-opioid only decedents were Non-Hispanic Black (all z-tests p-values <0.001). In the year before death, a larger proportion of decedents with concomitant detections filled benzodiazepine and/or buprenorphine prescriptions and were exposed to PIPPs (all z-tests p-values <0.05). Differences by demographic characteristics, time period of death, and history of buprenorphine and benzodiazepine prescriptions remained statistically significant in the multinomial logistic regression (all p-values < 0.05).To ensure that equitable policies and prevention programs are developed, more research is needed on (1) the intersectionality of demographic characteristics and the perceived risks, preferences, and access of non-opioids (including controlled drug prescriptions), and (2) the implications of current prescribing guidelines on people who may use multiple substances. [ABSTRACT FROM AUTHOR]

We evaluated the association of different types of educational visits for diabetic patients of the 8 Philadelphia Health Care Centers (HCCs), (public safety-net primary care clinics), with hospital admission rates and charges reported to the Pennsylvania Health Care Cost Containment Council. The data included all 18,416 HCC patients who had a visit with a diabetes diagnosis recorded between March 1, 1993 and December 31, 2001 and had at least one month followup time. Of these patients, 1059 (5.6%) had at least one diabetes class visit, 1673 (8.9%) had at least one nutritionist visit, and 333 (1.8%) had a health education visit; 2,472 (13.1%) patients had at least one of any of these types of visit. A total of 2,423 hospitalizations were recorded for 4,756 (25.8%) patients in the cohort. Among those who had at least one diabetes class, the mean number of classes was 5.6; among those who had at least one nutritionist visit, the mean number of such visits was 1.6; among those who had other health education visits, the mean number of such visits was 1.5. After adjustment for age, sex, race/ethnicity, and year of first diabetes diagnosis, having had any of the 3 types of educational visits was associated with 0.1185 fewer hospitalizations per year. When all 6 education variables (having had a nutritionist visit, diabetes class or other health education visit, and the number of visits of each of the three types) were tested simultaneously in multiple regression analyses, only having had a nutritionist visit was significantly associated with hospitalization rate. Having had a nutritionist visit was also the only variable independently associated with hospital charges, being associated with a reduction of $4,807 per year in hospital charges. Each nutritionist visit was associated with a $2,157 reduction in hospital charges, while each diabetes education class was associated with a $273 reduction. Any type of educational visit was associated with lower hospitalization rates, but nutritionist visits appear to have been more strongly associated with reduced hospitalizations than diabetes classes. Each nutritionist visit was associated with a significant annual reduction in hospital charges, suggesting that providing this service in the primary care setting may be highly cost-effective for the health care system. [ABSTRACT FROM AUTHOR]