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. 2004 Nov;96(11):1462–1469.

Comorbid disease and the effect of race and ethnicity on in-hospital mortality from aspiration pneumonia.

M Norman Oliver 1, George J Stukenborg 1, Douglas P Wagner 1, Frank E Harrell Jr 1, Kerry L Kilbridge 1, Jason A Lyman 1, Jonathan Einbinder 1, Alfred F Connors Jr 1
PMCID: PMC2568617  PMID: 15586650

Abstract

BACKGROUND: Racial and ethnic disparities in mortality have been demonstrated in several diseases. African Americans are hospitalized at a significantly higher rate than whites for aspiration pneumonia; however, no studies have investigated racial and ethnic disparities in mortality in this population. OBJECTIVE: To assess the independent effect of race and ethnicity on in-hospital mortality among aspiration pneumonia discharges while comprehensively controlling for comorbid diseases, and to assess whether the prevalence and effects of comorbid illness differed across racial and ethnic categories. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of 41,581 patients admitted to California hospitals for aspiration pneumonia from 1996 through 1998, using principal and secondary diagnoses present on admission. MEASUREMENT: The primary outcome measure was in-hospital mortality. RESULTS: The adjusted odds of in-hospital death for African-American compared with white discharges [odds ratio (OR)=1.01; 95% confidence interval (CI), 0.91-1.11] was not significantly different. The odds of death for Asian compared with white discharges was significantly lower (OR=0.83; 95% CI, 0.75-0.91). Hispanics had a significantly lower odds of death (OR=0.90; 95% CI, 0.82-0.988) compared to non-Hispanics. Comorbid diseases were more prevalent among African Americans and Asians than whites, and among Hispanics compared to non-Hispanics. Differences in effects of comorbid disease on mortality risk by race and ethnicity were not statistically significant. CONCLUSION: Asians have a lower risk of death, and the risk of death for African Americans is not significantly different from whites in this analysis of aspiration pneumonia discharges. Hispanics have a lower risk of death than non-Hispanics. While there are differences in prevalence of comorbid disease by racial and ethnic category, the effects of comorbid disease on mortality risk do not differ meaningfully by race or ethnicity.

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Selected References

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  1. Ash A., Shwartz M. R2: a useful measure of model performance when predicting a dichotomous outcome. Stat Med. 1999 Feb 28;18(4):375–384. doi: 10.1002/(sici)1097-0258(19990228)18:4<375::aid-sim20>3.0.co;2-j. [DOI] [PubMed] [Google Scholar]
  2. Baine W. B., Yu W., Summe J. P. Epidemiologic trends in the hospitalization of elderly Medicare patients for pneumonia, 1991-1998. Am J Public Health. 2001 Jul;91(7):1121–1123. doi: 10.2105/ajph.91.7.1121. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Becker L. B., Han B. H., Meyer P. M., Wright F. A., Rhodes K. V., Smith D. W., Barrett J. Racial differences in the incidence of cardiac arrest and subsequent survival. The CPR Chicago Project. N Engl J Med. 1993 Aug 26;329(9):600–606. doi: 10.1056/NEJM199308263290902. [DOI] [PubMed] [Google Scholar]
  4. Ebell M. H., Smith M., Kruse J. A., Drader-Wilcox J., Novak J. Effect of race on survival following in-hospital cardiopulmonary resuscitation. J Fam Pract. 1995 Jun;40(6):571–577. [PubMed] [Google Scholar]
  5. Fink A., Kosecoff J., Chassin M., Brook R. H. Consensus methods: characteristics and guidelines for use. Am J Public Health. 1984 Sep;74(9):979–983. doi: 10.2105/ajph.74.9.979. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Gijsen R., Hoeymans N., Schellevis F. G., Ruwaard D., Satariano W. A., van den Bos G. A. Causes and consequences of comorbidity: a review. J Clin Epidemiol. 2001 Jul;54(7):661–674. doi: 10.1016/s0895-4356(00)00363-2. [DOI] [PubMed] [Google Scholar]
  7. Gray R. J., Nessim S., Khan S. S., Denton T., Matloff J. M. Adverse 5-year outcome after coronary artery bypass surgery in blacks. Arch Intern Med. 1996 Apr 8;156(7):769–773. [PubMed] [Google Scholar]
  8. Greenwald H. P., Polissar N. L., Borgatta E. F., McCorkle R., Goodman G. Social factors, treatment, and survival in early-stage non-small cell lung cancer. Am J Public Health. 1998 Nov;88(11):1681–1684. doi: 10.2105/ajph.88.11.1681. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Hanley J. A., McNeil B. J. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology. 1982 Apr;143(1):29–36. doi: 10.1148/radiology.143.1.7063747. [DOI] [PubMed] [Google Scholar]
  10. Harrell F. E., Jr, Califf R. M., Pryor D. B., Lee K. L., Rosati R. A. Evaluating the yield of medical tests. JAMA. 1982 May 14;247(18):2543–2546. [PubMed] [Google Scholar]
  11. Harrell F. E., Jr, Lee K. L., Califf R. M., Pryor D. B., Rosati R. A. Regression modelling strategies for improved prognostic prediction. Stat Med. 1984 Apr-Jun;3(2):143–152. doi: 10.1002/sim.4780030207. [DOI] [PubMed] [Google Scholar]
  12. Harrell F. E., Jr, Lee K. L., Mark D. B. Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Stat Med. 1996 Feb 28;15(4):361–387. doi: 10.1002/(SICI)1097-0258(19960229)15:4<361::AID-SIM168>3.0.CO;2-4. [DOI] [PubMed] [Google Scholar]
  13. Jones J. Risk and outcome of aspiration pneumonia in a city hospital. J Natl Med Assoc. 1993 Jul;85(7):533–536. [PMC free article] [PubMed] [Google Scholar]
  14. Mark D. H. Race and the limits of administrative data. JAMA. 2001 Jan 17;285(3):337–338. doi: 10.1001/jama.285.3.337. [DOI] [PubMed] [Google Scholar]
  15. McKee M., Shkolnikov V., Leon D. A. Alcohol is implicated in the fluctuations in cardiovascular disease in Russia since the 1980s. Ann Epidemiol. 2001 Jan;11(1):1–6. doi: 10.1016/s1047-2797(00)00080-6. [DOI] [PubMed] [Google Scholar]
  16. Mickelson J. K., Blum C. M., Geraci J. M. Acute myocardial infarction: clinical characteristics, management and outcome in a metropolitan Veterans Affairs Medical Center teaching hospital. J Am Coll Cardiol. 1997 Apr;29(5):915–925. doi: 10.1016/s0735-1097(97)00034-x. [DOI] [PubMed] [Google Scholar]
  17. Muder R. R. Pneumonia in residents of long-term care facilities: epidemiology, etiology, management, and prevention. Am J Med. 1998 Oct;105(4):319–330. doi: 10.1016/s0002-9343(98)00262-9. [DOI] [PubMed] [Google Scholar]
  18. Siddique R. M., Siddique M. I., Connors A. F., Jr, Rimm A. A. Thirty-day case-fatality rates for pulmonary embolism in the elderly. Arch Intern Med. 1996 Nov 11;156(20):2343–2347. [PubMed] [Google Scholar]
  19. Smith T. J., Penberthy L., Desch C. E., Whittemore M., Newschaffer C., Hillner B. E., McClish D., Retchin S. M. Differences in initial treatment patterns and outcomes of lung cancer in the elderly. Lung Cancer. 1995 Dec;13(3):235–252. doi: 10.1016/0169-5002(95)00496-3. [DOI] [PubMed] [Google Scholar]
  20. Stewart J. H., 4th Lung carcinoma in African Americans: a review of the current literature. Cancer. 2001 Jun 15;91(12):2476–2482. [PubMed] [Google Scholar]

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