Is Lower 30-Day Mortality Posthospital Admission Among Blacks Unique to the Veterans Affairs Health Care System?

Polsky, Daniel; Lave, Judith R.; Klusaritz, Heather; Jha, Ashish K.; Pauly, Mark V.; Cen, Liyi; Stone, Roslyn A.; Chen, Zhen; Volpp, Kevin G.

doi:10.1097/mlr.0b013e3180ca960e

Cited by 24 publications

(25 citation statements)

References 28 publications

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“…Our findings support previous research from administrative data and stroke registries, suggesting that racial/ethnic minority groups have a lower risk for short-term all-cause mortality after being hospitalized for AIS than non-Hispanic white patients. 9,[29][30][31][32] One possible explanation for such findings is that there are relatively high rates for small vessel lacunar and intracranial atherosclerotic stroke types compared with large-vessel cardioembolic stroke type among racial/ethnic minority patients compared with non-Hispanic whites. 4,[33][34][35][36] Another possible explanation is that racial/ethnic minority patients might receive intensive life-sustaining interventions more often, which could lead to a short-term survival advantage.…”

Section: Discussionmentioning

confidence: 94%

Racial and Ethnic Differences in Outcomes in Older Patients With Acute Ischemic Stroke

Qian

Fonarow

Smith

et al. 2013

Circ: Cardiovascular Quality and Outcomes

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Background— Little is known as to whether long-term outcomes of acute ischemic stroke (AIS) vary by race/ethnicity. Using the American Heart Association Get With The Guidelines–Stroke registry linked with Medicare claims data set, we examined whether 30-day and 1-year outcomes differed by race/ethnicity among older patients with AIS. Methods and Results— We analyzed 200 900 patients with AIS >65 years of age (170 694 non-Hispanic whites, 85.0%; 20 514 non-Hispanic blacks, 10.2%; 6632 Hispanics, 3.3%; 3060 non-Hispanic Asian Americans, 1.5%) from 926 US centers participating in the Get With The Guidelines–Stroke program from April 2003 through December 2008. Compared with whites, other racial and ethnic groups were on average younger and had a higher median score on the National Institutes of Health Stroke Scale. Whites had higher 30-day unadjusted mortality than other groups (white versus black versus Hispanic versus Asian=15.0% versus 9.9% versus 11.9% versus 11.1%, respectively). Whites also had higher 1-year unadjusted mortality (31.7% versus 28.6% versus 28.1% versus 23.9%, respectively) but lower 1-year unadjusted all-cause rehospitalization (54.7% versus 62.5% versus 60.0% versus 48.6%, respectively). After risk adjustment, Asian American patients with AIS had lower 30-day and 1-year mortality than white, black, and Hispanic patients. Relative to whites, black and Hispanic patients had higher adjusted 1-year all-cause rehospitalization (black: adjusted odds ratio, 1.28 [95% confidence interval, 1.21–1.37]; Hispanic: adjusted odds ratio, 1.22 [95% confidence interval, 1.11–1.35]), whereas Asian patients had lower odds (adjusted odds ratio, 0.83 [95% confidence interval, 0.74–0.94]). Conclusions— Among older Medicare beneficiaries with AIS, there were significant differences in long-term outcomes by race/ethnicity, even after adjustment for stroke severity, other prognostic variables, and hospital characteristics.

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Section: Discussionmentioning

confidence: 94%

Racial and Ethnic Differences in Outcomes in Older Patients With Acute Ischemic Stroke

Qian

Fonarow

Smith

et al. 2013

Circ: Cardiovascular Quality and Outcomes

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“…A "reverse disparity" in the race-mortality relationship, where NHB elderly (>65 years old) have a survival benefit over elderly NHW, has been demonstrated in studies examining allcause or specific cause-related deaths in individuals with diabetes [8][9][10][21][22][23] . The sample in this study represents an older (generally elderly) cohort of individuals with type 2 diabetes.…”

Section: Discussionmentioning

confidence: 96%

“…While there is an established evidence base for differences in mortality among blacks and whites, racial disparities in mortality among a high-risk population of veterans with diabetes lacks strong convincing data. The results of several large-scale studies have used administrative data to support the finding of lower mortality among elderly black veterans 8 ; not among those younger than 65 years of age 9,10 . A major limitation of administrative datasets in reporting disease states is its heavy dependence on accurate coding for record-keeping and/or payment purposes 11 rather than accurate patient-level data, thus providing a picture for disease burden but lacking in other important confounders.…”

Section: Introductionmentioning

confidence: 90%

Racial Disparities in All-Cause Mortality Among Veterans with Type 2 Diabetes

et al. 2010

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BACKGROUND: Racial differences in mortality among veterans with diabetes are less well characterized than those in the general population. OBJECTIVE: To examine racial differences in all-cause mortality in a large sample of veterans with diabetes. DESIGN: A retrospective cohort. PARTICIPANTS: Participants comprised 8,812 veterans with type 2 diabetes. MEASUREMENTS: The main outcome measure was time to death. The main predictor was race/ethnicity. Other risk factors (or covariates) included age, gender, marital status, employment, glycosylated hemoglobin (HgbA1c), and several ICD-9 coded physical and mental health comorbidities. RESULTS: Average follow-up was 4.5 years; 64% of veterans were non-Hispanic whites (NHW), 97% male, and 84% at least 50 years old. The overall mortality rate was 15% and was significantly lower for non-Hispanic blacks (NHB). Baseline HgbA1c values also differed for NHW (mean=7.05) and NHB (mean=7.65) (p<0.001). In sequentially-built models NHB race was associated with a lower risk of mortality with HR ranging 0.80-0.92. After adjusting for all significant covariates, the risk of mortality remained lower for NHB (HR=0.84, 95% CI: 0.75, 0.94). Increased mortality risk was associated with age, not being employed or retired, poor glycemic control, cancer, Coronary Heart Disease (CHD), and anxiety disorder; while a lower risk was associated with being female and ever being married. CONCLUSIONS: The risk of death among NHB veterans with diabetes remained significantly lower than that of NHW after controlling for important confounding variables. Future studies in the VA need to examine detailed contributions of patient, provider and system-level factors on racial differences in mortality in adults with diabetes, especially if the findings of this study are replicated at other sites or using national VA data.

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“…The single study that addressed timeliness of care showed worse performance among veterans in VA facilities relative to non-VA facilities for time between hospital admission for hip fracture and surgical repair. 37 Four studies examined equity, with one study showing better performance on several chronic disease and preventive measures, 51 one study showing worse performance in VA facilities for emergency room visits among cancer patients in the last month of life, 76 and two studies showing similar equity in 30-day post-admission mortality 78 and graft failure. 27 Nine articles compared efficiency using utilization, with six studies showing worse performance in VA facilities on outcomes such as average length of stay and service utilization for patients on dialysis, 32,61,[79][80][81][82] two showing better performance for visits/ admissions 83 and generic drug utilization, 84 and one with mixed results for utilization-related inpatient quality indicators.…”

Section: Safetymentioning

confidence: 99%

Comparing VA and Non-VA Quality of Care: A Systematic Review

et al. 2016

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Is Lower 30-Day Mortality Posthospital Admission Among Blacks Unique to the Veterans Affairs Health Care System?

Abstract: These findings suggest that factors associated with better short-term outcomes for blacks are not unique to the VA.

Cited by 24 publications

References 28 publications

Racial and Ethnic Differences in Outcomes in Older Patients With Acute Ischemic Stroke

Racial and Ethnic Differences in Outcomes in Older Patients With Acute Ischemic Stroke

Racial Disparities in All-Cause Mortality Among Veterans with Type 2 Diabetes

Comparing VA and Non-VA Quality of Care: A Systematic Review

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