Lower Mortality for African American Veterans with COPD Exacerbation not Explained by More Aggressive Care
Some studies have shown that African American patients are more likely than white patients to prefer and receive more life-sustaining interventions ("aggressive care") in advanced stages of disease. However, no studies have examined whether the lower mortality in African Americans for some conditions may be due to racial differences in the use of aggressive care. This study sought to determine the potential impact of racial differences in ICU admission and the use of ventilator support on mortality among 7,159 African American Veterans and 43,820 white Veterans admitted to VA hospitals with COPD (chronic obstructive pulmonary disease) from 10/02-9/06. Investigators used VA data to compare mortality occurring in-hospital or within 30 days of admission, in addition to rates of admission to the ICU, and use of mechanical or non-invasive ventilation.
Findings show that mortality was lower in African American Veterans compared to white Veterans admitted for COPD exacerbation, even after adjusting for differences in ICU admission rates and ventilator support. However, mortality was similar for African Americans and whites receiving mechanical ventilation (28.8% vs. 31.4%), thus the lower risk-adjusted mortality among African Americans was not explained by more aggressive care. Study results also show that African American Veterans were more likely to be admitted to an ICU compared to white Veterans (19.1% vs. 17.2%). Mortality rates were lower among African American Veterans compared to white Veterans admitted to ICUs (16.9% vs. 20.3%), as well as non-ICU wards (4.8% vs. 6.9%).
Sarrazin M, Cannon K, Rosenthal G, and Kaldjian L. Racial differences in mortality among Veterans hospitalized for COPD exacerbation. Journal of the National Medical Association July 2009;101(7):656-662.
Dr. Cannon was supported by a VA Quality Scholars Fellowship. At the time of the study, all authors were affiliated with HSR&D's Center for Research in the Implementation of Innovative Strategies in Practice in Iowa City, Iowa.