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Med Care. 2018 Aug;56(8):665-672. doi: 10.1097/MLR.0000000000000938.

Is 30-Day Posthospitalization Mortality Lower Among Racial/Ethnic Minorities?: A Reexamination.

Author information

1
Section of General Internal Medicine, Boston University School of Medicine.
2
VA Boston Healthcare System, Boston, MA.
3
Division of General Internal Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, NY.
4
Department of Medicine, Section of Hospital Medicine, University of California, San Francisco, CA.
5
Department of Surgery, MedSTAR Washington Hospital Center, Washington, DC.

Abstract

BACKGROUND:

Multiple studies have reported that risk-adjusted rates of 30-day mortality after hospitalization for an acute condition are lower among blacks compared with whites.

OBJECTIVE:

To examine if previously reported lower mortality for minorities, relative to whites, is accounted for by adjustment for do-not-resuscitate status, potentially unconfirmed admission diagnosis, and differential risk of hospitalization.

RESEARCH DESIGN:

Using inpatient discharge and vital status data for patients aged 18 and older in California, we examined all admissions from January 1, 2010 to June 30, 2011 for acute myocardial infarction, heart failure, pneumonia, acute stroke, gastrointestinal bleed, and hip fracture and estimated relative risk of mortality for Hispanics, non-Hispanic blacks, non-Hispanic Asians, and non-Hispanic whites. Multiple mortality measures were examined: inpatient, 30-, 90-, and 180 day. Adding census data we estimated population risks of hospitalization and hospitalization with inpatient death.

RESULTS:

Across all mortality outcomes, blacks had lower mortality rate, relative to whites even after exclusion of patients with do-not-resuscitate status and potentially unconfirmed diagnosis. Compared with whites, the population risk of hospitalization was 80% higher and risk of hospitalization with inpatient mortality was 30% higher among blacks. Among Hispanics and Asians, disparities varied with mortality measure.

CONCLUSIONS:

Lower risk of posthospitalization mortality among blacks, relative to whites, may be associated with higher rate of hospitalizations and differences in unobserved patient acuity. Disparities for Hispanics and Asians, relative to whites, vary with the mortality measure used.

PMID:
29877955
PMCID:
PMC6041156
[Available on 2019-08-01]
DOI:
10.1097/MLR.0000000000000938

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