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African Americans Have Better Outcomes for Five Common Gastrointestinal Diagnoses in Hospitals With More Racially Diverse Patients

The American Journal of Gastroenterology volume 111, pages 649657 (2016) | Download Citation



We sought to characterize the relationship between hospital inpatient racial diversity and outcomes for African-American patients including rates of major complications or mortality during hospitalization for five common gastrointestinal diagnoses.


Using the 2012 National Inpatient Sample database, hospital inpatient racial diversity was defined as the percentage of African-American patients discharged from each hospital. Logistic regression was used to predict major complication rates or death, long length of stay, and high total charges. Control variables included age, gender, payer type, patient location, area-associated income quartile, hospital characteristics including size, urban vs. rural, teaching vs. nonteaching, region, and the interaction of the percentage of African Americans with patient race.


There were 848,395 discharges across 3,392 hospitals. The patient population was on average 27% minority (s.d.±21%) with African Americans accounting for 14% of all patients. Overall, African-American patients had higher rates of major complications or death relative to white patients (adjusted odds ratio (aOR) 1.19; 95% confidence interval (CI) 1.16–1.23). However, when treated in hospitals with higher patient racial diversity, African-American patients experienced significantly lower rates of major complications or mortality (aOR 0.80; 95% CI 0.74–0.86).


African Americans have better outcomes for five common gastrointestinal diagnoses when treated in hospitals with higher inpatient racial diversity. This has major ramifications on total hospital charges.

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Author notes

    • Philip N Okafor
    •  & Derrick J Stobaugh

    These authors are co-first authors


  1. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA

    • Philip N Okafor
    •  & Jayant A Talwalkar
  2. NorthShore University Health System, Skokie, Illinois, USA

    • Derrick J Stobaugh
  3. Graham School, University of Chicago, Chicago, Illinois, USA

    • Derrick J Stobaugh
  4. Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA

    • Michelle van Ryn
    •  & Jayant A Talwalkar


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Competing interests

Guarantor of the article: Philip N. Okafor, MD, MPH.

Specific author contributions: Philip N. Okafor: study design, literature review, data acquisition, interpretation, and preparation of the manuscript; Derrick J. Stobaugh: study concept and design, literature review, data acquisition, analysis, and interpretation, and manuscript preparation; Michelle van Ryn: critical revision of manuscript for important intellectual content; Jayant A. Talwalkar: study concept, design, and critical revision of manuscript for important intellectual content, and study supervision.

Financial support: None.

Potential competing interests: None.

Corresponding author

Correspondence to Philip N Okafor.



Table 5: Appendix Table 1. Impact of hospital patient racial diversity on outcomes in African-American patients in 2013
Table 6: Appendix Table 2. Measures of model fit for 2012 and 2013 data

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