Racial and Ethnic Disparities in Pneumonia Treatment and Mortality
Center for Health Equity Research and Promotion, VA Pittsburgh Health Care System, Pittsburgh, Pennsylvania 15206, USA. Medical Care
(Impact Factor: 3.23).
08/2009; 47(9):1009-1017. DOI: 10.1097/MLR.0b013e3181a80fdc
Background: The extent to which racial/ethnic disparities in pneumonia care occur within or between hospitals is unclear.
Objective: Examine within and between-hospital racial/ethnic disparities in quality indicators and mortality for patients hospitalized for pneumonia.
Research Design: Retrospective cohort study.
Subjects: A total of 1,183,753 non-Hispanic white, African American, and Hispanic adults hospitalized for pneumonia between January 2005 and June 2006.
Measures: Eight pneumonia care quality indicators and in-hospital mortality.
Results: Performance rates for the 8 quality indicators ranged from 99.4% (oxygenation assessment within 24 hours) to 60.2% (influenza vaccination). Overall hospital mortality was 4.1%. African American and Hispanic patients were less likely to receive pneumococcal and influenza vaccinations, smoking cessation counseling, and first dose of antibiotic within 4 hours than white patients at the same hospital (ORs = 0.65-0.95). Patients at hospitals with the racial composition of those attended by average African Americans and Hispanics were less likely to receive all indicators except blood culture within 24 hours than patients at hospitals with the racial composition of those attended by average whites. Hospital mortality was higher for African Americans (OR = 1.05; 95% CI = 1.02, 1.09) and lower for Hispanics (OR = 0.85; 95% CI = 0.81, 0.89) than for whites within the same hospital. Mortality for patients at hospitals with the racial composition of those attended by average African Americans (OR = 1.21; 95% CI = 1.18, 1.25) or Hispanics (OR = 1.18; 95% CI = 1.14, 1.23) was higher than for patients at hospitals with the racial composition of those attended by average whites.
Conclusions: Racial/ethnic disparities in pneumonia treatment and mortality are larger and more consistent between hospitals than within hospitals.
Available from: Christopher Raymond Frei
- "These processes have been recommended by professional medical societies, clinical practice guidelines, hospital accreditation commissions, and federal agencies ; however, whether such processes of care are performed in an equitable manner for patients of all races is unclear. While some studies have demonstrated African-American patients are less likely to receive timely initiation of antibiotic therapy, diagnostic bronchoscopy, smoking cessation counseling, and pneumococcal and influenza vaccinations [1,3,13,14], the available evidence suggests no difference between African-Americans and Caucasians in the likelihood of receiving guideline-concordant antibiotic therapy, blood cultures, or assessment of arterial oxygenation [3,14]. "
[Show abstract] [Hide abstract]
ABSTRACT: 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.
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 <or= 0.0001.
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).
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.
[Show abstract] [Hide abstract]
ABSTRACT: We present methods for calibrating microstrip devices and circuits using coplanar microprobes and TRL calibration. An on-chip CPW to microstrip transition  is employed to measure accurate S-parameters to 50 GHz [1,2]. A CAD model, developed for the transition, is used to de-embed measured results when using a commercial calibration substrate with measurement reference planes at the probe tips. We also make TRL calibration artifacts which include CPW to microstrip transitions in the standards so that we can use the TFX algorithm to de-embed adapters on the ANA. These test methodologies can be used to characterize many types of microstrip devices including printed wire boards and thick film microwave substrates.
[Show abstract] [Hide abstract]
ABSTRACT: Les métastases hypophysaires et la sarcoïdose sont deux causes connues de l’épaississement de la tige pituitaire. Leur association est décrite depuis 3 décennies. Nous rapportons dans ce cadre, un cas rare de panhypopituitarisme révélant une métastase pituitaire d’un carcinome pulmonaire à petites cellules associé à une sarcoïdose.Il s’agit d’un patient âgé de 49 ans tabagique et diabétique type 2, hospitalisé dans un tableau d’insuffisance surrénalienne aiguë avec un syndrome polyuro-polydipsique et un syndrome tumoral hypophysaire. L’exploration hormonale a confirmé l’insuffisance antéhypophysaire globale et le test de restriction hydrique a été en faveur d’un diabète insipide central. L’IRM hypothalamo-hypophysaire a montré un processus expansif intrasellaire de 1 cm avec épaississement nodulaire de la tige. La radio thorax a montré une opacité basale gauche hétérogène mal limitée. Le scanner thoraco-abdominal a objectivé la présence, au niveau du champ pulmonaire gauche, d’une masse tumorale très suspecte de malignité avec multiples adénopathies médiastinales, de multiples nodules hépatiques et une hypertrophie de la surrénale gauche. Une fibroscopie bronchique, réalisée à trois reprises, a montré une infiltration sténosante de l’arbre bronchique gauche mais l’étude anatomopathologique des biopsies bronchiques a été toujours non concluante. Une ponction biopsie du foie sous échographie a été alors réalisée et l’étude anatomopathologique a trouvé l’aspect d’une hépatite granulomateuse chronique compatible avec une sarcoïdose.Le diagnostic de sarcoïdose n’a pu être retenu comme cause de l’atteinte pulmonaire surtout devant l’altération de l’état général du patient. Le contrôle radiologique a montré une évolution lésionnelle importante et l’étude anatomopathologique d’une biopsie trans-thoracique sous scanner a mis en évidence la présence d’un carcinome à petites cellules.Chez l’homme, le carcinome à petites cellules est le cancer qui se complique le plus fréquemment de métastases hypophysaires. L’association sarcoïdose - néoplasie reste controversée. Le lien entre les deux est jusque là non prouvé avec risque élevé d’erreur de classification.Pituitary metastasis and sarcoidosis are two causes of pituitary stalk thickening. Their association has been described ago three decades. In this setting, we report a case of panhypopituitarism revealing pituitary metastasis from a small-cell lung carcinoma associated with sarcoidosis.A 49 year-old smoking patient with type 2 diabetes was admitted for acute adrenal failure with polyuria polydipsia syndrome and a pituitary tumor syndrome. Hormone explorations confirmed anterior pituitary insufficiency. Water restriction revealed central diabetes insipidus. The hypothalamic-pituitary MRI revealed a 1-cm sellar mass with nodular thickening of the stalk. The chest radiograph showed a heterogeneous opacity in the left lung. The thoraco-abdominal scan demonstrated a mass in the left lung highly suggestive of malignancy and many enlarged mediastinal nodes, hepatic nodules, and hypertrophy of the left adrenal.Bronchoscopy was performed three times and showed infiltration of the left bronchial tree but histological examination of the bronchial biopsies was negative for all samples. Ultrasound-guided biopsy of the liver was achieved and histology demonstrated sarcoidosis.The diagnosis of sarcoidosis was incompatible with the deterioration of the patient's general status. Subsequent radiographic explorations showed an increase in the size of the tumor mass and histological evaluation of a scan-guided trans-thoracic biopsy demonstrated small-cell carcinoma.Small-cell lung carcinoma is the most common cancer with pituitary metastasis. The proposed link between sarcoidosis and malignancy has remained controversial but has not been proven false.
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.