Sex and racial disparities in clinical outcomes and healthcare costs among hospitalized older adult fall patients: A nationwide analysis

Abstract

Background

The impact of patient sex and race on clinical in-hospital outcomes and expenditures of falls in older adults remain underexplored. This study examines sex- and race-based disparities of fall-related hospitalizations.

Study design

All hospitalizations for adults (≥65 years) from falls were identified (National Inpatient Sample, 2017–2021). Patients were stratified into sex and racial groups (White and Non-White). Multivariable logistic (dichotomous variables) and linear (continuous variables) regression modeling compared clinical in-hospital outcomes, resource utilization, and hospital costs stratified by sex and race.

Results

An estimated 5,870,482 (survey-weighted) older adults experienced a fall-related hospital admission, with annual incidence rising from 1,108,024 to 1,210,547 (P < 0.001). Unadjusted in-hospital mortality was lower for females compared to males (2.5 vs 4.5 %, P < 0.001). Following risk-adjustment, females had lower odds of in-hospital mortality (AOR: 0.59, 95 %CI: 57–0.60, P < 0.001) and costs (β = −$1344, 95 %CI: −1321 to −1267, P < 0.001).

On crude analysis, in-hospital mortality was higher in Non-White patients (3.4 vs 3.2 %, P < 0.001). Mean LOS was longer for Non-White (6.31 ± 7.69 days) compared to White patients (5.65 ± 5.93 days, P < 0.001). Following risk-adjustment, Non-White patients had higher odds of in-hospital mortality compared to White patients (AOR: 1.16, 95 %CI: 1.08–1.24, P < 0.001) and higher median costs (β = $2304, 95 %CI: 1897.90-2710.16, P < 0.001).

Conclusion

Sex and race are associated with differences in clinical in-hospital outcomes and expenditures in older adult fall hospitalizations, suggesting potential variations in treatment, recovery, and access to care. Further research is needed to better understand these disparities and inform strategies for more equitable care.