Link to the University of Pittsburgh Homepage
Link to the University Library System Homepage Link to the Contact Us Form

Disparities of care for african-americans and caucasians with community-acquired pneumonia: A retrospective cohort study

Frei, CR and Mortensen, EM and Copeland, LA and Attridge, RT and Pugh, MJV and Restrepo, MI and Anzueto, A and Nakashima, B and Fine, MJ (2010) Disparities of care for african-americans and caucasians with community-acquired pneumonia: A retrospective cohort study. BMC Health Services Research, 10.

[img]
Preview
PDF
Published Version
Available under License : See the attached license file.

Download (602kB) | Preview
[img] Plain Text (licence)
Available under License : See the attached license file.

Download (1kB)

Abstract

Background. African-Americans admitted to U.S. hospitals with community-acquired pneumonia (CAP) are more likely than Caucasians to experience prolonged hospital length of stay (LOS), possibly due to either differential treatment decisions or patient characteristics. Methods. We assessed associations between race and outcomes (Intensive Care Unit [ICU] variables, LOS, 30-day mortality) for African-American or Caucasian patients over 65 years hospitalized in the Veterans Health Administration (VHA) with CAP (2002-2007). Patients admitted to the ICU were analyzed separately from those not admitted to the ICU. VHA patients who died within 30 days of discharge were excluded from all LOS analyses. We used chi-square and Fisher's exact statistics to compare dichotomous variables, the Wilcoxon Rank Sum test to compare age by race, and Cox Proportional Hazards Regression to analyze hospital LOS. We used separate generalized linear mixed-effect models, with admitting hospital as a random effect, to examine associations between patient race and the receipt of guideline-concordant antibiotics, ICU admission, use of mechanical ventilation, use of vasopressors, LOS, and 30-day mortality. We defined statistical significance as a two-tailed p 0.0001. Results. Of 40,878 patients, African-Americans (n = 4,936) were less likely to be married and more likely to have a substance use disorder, neoplastic disease, renal disease, or diabetes compared to Caucasians. African-Americans and Caucasians were equally likely to receive guideline-concordant antibiotics (92% versus 93%, adjusted OR = 0.99; 95% CI = 0.81 to 1.20) and experienced similar 30-day mortality when treated in medical wards (adjusted OR = 0.98; 95% CI = 0.87 to 1.10). African-Americans had a shorter adjusted hospital LOS (adjusted HR = 0.95; 95% CI = 0.92 to 0.98). When admitted to the ICU, African Americans were as likely as Caucasians to receive guideline-concordant antibiotics (76% versus 78%, adjusted OR = 0.99; 95% CI = 0.81 to 1.20), but experienced lower 30-day mortality (adjusted OR = 0.82; 95% CI = 0.68 to 0.99) and shorter hospital LOS (adjusted HR = 0.84; 95% CI = 0.76 to 0.93). Conclusions. Elderly African-American CAP patients experienced a survival advantage (i.e., lower 30-day mortality) in the ICU compared to Caucasians and shorter hospital LOS in both medical wards and ICUs, after adjusting for numerous baseline differences in patient characteristics. There were no racial differences in receipt of guideline-concordant antibiotic therapies. © 2010 Frei et al.


Share

Citation/Export:
Social Networking:
Share |

Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Frei, CR
Mortensen, EM
Copeland, LA
Attridge, RT
Pugh, MJV
Restrepo, MI
Anzueto, A
Nakashima, B
Fine, MJmjf1@pitt.eduMJF1
Date: 31 May 2010
Date Type: Publication
Journal or Publication Title: BMC Health Services Research
Volume: 10
DOI or Unique Handle: 10.1186/1472-6963-10-143
Schools and Programs: School of Medicine > Medicine
Refereed: Yes
Date Deposited: 10 Nov 2016 16:20
Last Modified: 01 Mar 2019 13:56
URI: http://d-scholarship.pitt.edu/id/eprint/30280

Metrics

Monthly Views for the past 3 years

Plum Analytics

Altmetric.com


Actions (login required)

View Item View Item