Racial differences in mortality among veterans hospitalized for exacerbation of chronic obstructive pulmonary disease

Abstract

This study compared mortality in African American and white patients admitted to veterans affairs (VA) hospitals for chronic obstructive pulmonary disease (COPD) exacerbation and determined the potential impact of differences in intensive care unit (ICU) admission and mechanical ventilation. Administrative data from 2003-2006 identified African American (n = 7159) and white (n = 43820) patients admitted to VA hospitals with COPD exacerbation. Hierarchical logistic regression was used to compare risk-adjusted 30-day or in-hospital mortality in African American and white patients. African Americans were more likely than whites to be admitted to ICUs (19.1% vs 17.2%, respectively; p < .001) and to receive mechanical ventilation (4.8% vs 4.1%, p < .001). African Americans had lower unadjusted mortality than white patients overall (7.1% vs 9.2%, p < .001), and among patients admitted to ICUs (16.9% vs 20.3%, p < .01) and non-ICU wards (4.8% vs 6.9%, p < .001). Mortality was similar for African Americans and whites receiving mechanical ventilation (28.8% vs 31.4%, p = .34). The risk-adjusted odds of death were lower for African Americans relative to white patients (OR, 0.71; p < .001) and in analyses that further adjusted for ICU admission and ventilation use (OR, 0.69; p < .001). Mortality was lower in African Americans than white veterans admitted for COPD exacerbation, even after adjusting for differences in ICU admission rates and ventilatory support. The lower risk-adjusted mortality in African Americans was not explained by more aggressive care.