Blacks more likely to leave hospital against advice

NEW YORK (Reuters Health) - African Americans are more likely than their white or Hispanic counterparts to check themselves out of the hospital against their doctors' advice, a new study has found.

In an analysis of more than 3 million discharges from U.S. hospitals in 2002, the researchers found that 1.4 percent were made against medical advice. Compared with white patients, African Americans were 35 percent more likely to opt for such a "self-discharge," the researchers report in the American Journal of Public Health.

In contrast, Hispanic patients were 10 percent less likely than whites to check out against medical advice, Dr. Said A. Ibrahim of the Veterans Administration Pittsburgh Healthcare System and co-investigators report.

While the reasons for these findings are not completely clear, they speculate that distrust of doctors or a history of bad experiences with the healthcare system may partially explain African Americans' higher likelihood of self-discharge.

In some cases, the researchers note, patients may need to care for children or other family members, or may be worried about missing work.

Ibrahim and his colleagues based their findings on hospital discharge data for just over 3 million adult patients at hundreds of U.S. hospitals.

Along with race, other factors appeared to increase the risk of patients checking out against medical advice. Patients receiving Medicaid, the government health insurance program for the poor, were three times more likely than patients with private insurance to self-discharge. Also at greater risk were patients on Medicare, the federal insurance program for older Americans. Younger patients self-discharged more often than older patients, and men did so more often than women.

Even with factors like insurance and income considered, however, African-American race was still independently linked to a higher risk of self-discharge. Figuring out why this is, and how to address the discrepancy, will be important, according to Ibrahim's team.

Past studies, they note, have shown that people who leave the hospital against advice are at risk of re-admission and subsequently longer hospital stays, as well as poorer health in the long run.

SOURCE: American Journal of Public Health, December 2007.