Black Patients Hospitalized With Skin Ulcers Have Greater Length of Stay

These findings provide greater insight regarding racial and ethnic differences for inpatient dermatologic care.

Racial and ethnic differences occur in patients hospitalized with skin ulcers, with non-Hispanic Black patients having a greater length of stay and charges, according to study findings published in Archives of Dermatological Research.

Researchers conducted a retrospective cohort study based on data from the Statewide Planning and Research Cooperative System database, which is a de-identified, patient-level dataset of inpatient visits with skin ulcers in New York State from 2009 to 2021.

Outcomes included length of stay, total charges, and discharge location for White, Black, and Hispanic patients in unadjusted and mixed effects modeling. Adjusted models included age, sex, race, ethnicity, health insurance type, facility, and mortality risk as potential confounders.

The study cohort included 41,148 patients, among whom 589 were Hispanic Black (47% women), 1790 were Hispanic White (40% women), 13,065 were non-Hispanic Black (50% women), and 25,704 were non-Hispanic White (46% women). Most participants in each group were aged 50 years and older.

The reasons for these differences merit investigation, yet could be related to outpatient care delays, more severe disease, comorbid conditions, or complications…

Non-Hispanic Black patients had a greater mean length of stay (8.15 vs 7.48 days; P =.009), increased hospital charges ($44,400 vs $37,600; P <.001), and were discharged home without services more frequently (38.1% vs 32.4%; P <.001) compared with non-Hispanic White patients.

Hispanic Black patients had a similar mean length of stay and patient disposition, but had higher mean charges ($45,800 vs $36,700; P =.031) compared with Hispanic White patients. After adjustment, non-Hispanic Black patients had a longer length of stay by 0.26 days (P =.028) and $2331 higher charges (P =.001) compared with non-Hispanic White patients.

Study limitations include the fact that few of the hospitals had hospice services. Also, no data were available on ulcer severity or type to include as potential confounders.

The researchers conclude, “The reasons for these differences merit investigation, yet could be related to outpatient care delays, more severe disease, comorbid conditions, or complications…” They continued, “The associated higher charges for Black patients may pose financial challenges given they more frequently had Medicaid or were self-pay. It is unclear why [length of stay] among Hispanic patients was shorter, yet these patients were more frequently discharged home without health services, which could have expedited discharges for logistical reasons.”

Disclosure: One of the study authors declared an affiliation with medical technology companies. Please see the original reference for a full list of disclosures.


Hardy NJ, Gronbeck C, Feng H. Impact of race and ethnicity on length of stay, discharge location, and total charges for inpatients with skin ulcers in New York. Arch Dermatol Res. Published online April 16, 2023. doi:10.1007/s00403-023-02624-3