Short‐ and Long‐Term Mortality after an Acute Illness for Elderly Whites and Blacks

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

doi:10.1111/j.1475-6773.2008.00837.x

Cited by 41 publications

(52 citation statements)

References 30 publications

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“…Level 1 demographics were most commonly evaluated, and of the studies that did multivariate analyses, increased mortality was observed for older 8,16,20,[24][25][26] and male 8,20,24 patients. The pattern for race was mixed with one study showing decreased mortality 27 for blacks and two showing no statistical difference. 27,28 Hispanics 25 and Asians 25 had lower mortality.…”

Section: Social Factors Associated With Mortality In Pneumoniamentioning

confidence: 96%

“…The pattern for race was mixed with one study showing decreased mortality 27 for blacks and two showing no statistical difference. 27,28 Hispanics 25 and Asians 25 had lower mortality. Level 2 and 3 social factors were examined less frequently.…”

Section: Social Factors Associated With Mortality In Pneumoniamentioning

confidence: 96%

“…Black HF patients had decreased mortality. 9,27,37,51 Level 2 factors that were examined but were not significant included insurance, 57 education, 55 and socioeconomic status. 45 Abrams et al 29 showed that patients with a psychiatric comorbidity had decreased odds of mortality.…”

Section: Social Factors Associated With Mortality In Heart Failurementioning

confidence: 99%

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Impact of Social Factors on Risk of Readmission or Mortality in Pneumonia and Heart Failure: Systematic Review

et al. 2012

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Section: Social Factors Associated With Mortality In Pneumoniamentioning

confidence: 96%

Section: Social Factors Associated With Mortality In Pneumoniamentioning

confidence: 96%

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Impact of Social Factors on Risk of Readmission or Mortality in Pneumonia and Heart Failure: Systematic Review

et al. 2012

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“…differences in short-term survival may also reflect a "survivor effect" in which blacks who survive to age 65 may represent a healthier cohort of patients than white patients of the same age. [13][14][15] It is also unknown whether black patients with larger MIs may be more likely to die before reaching the hospital; therefore, those blacks who are admitted may have less severe disease than whites. In addition to age and sex, there are likely additional unmeasured differences between these groups that confer a protective benefit toward black patients that we have not fully captured or adjusted for.…”

Section: Short-term Mortalitymentioning

confidence: 99%

“…Several prior analyses have found similar results of a short-term survival advantage among blacks compared with whites for cardiac and noncardiac conditions. [13][14][15]24,25 One possibility for these findings in black patients may be the higher prevalence of type 2 or secondary MIs seen in the setting of renal failure or hypertensive disease. These MIs are caused by increased oxygen demand or decreased oxygen supply rather than acute plaque rupture 26 and are often associated with smaller infarct size and less myocardial damage as evidenced by lower troponin elevations.…”

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confidence: 97%

Differences in Short-Term Versus Long-Term Outcomes of Older Black Versus White Patients With Myocardial Infarction

et al. 2014

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Background-Blacks are less likely than whites to receive coronary revascularization and evidence-based therapies after acute myocardial infarction, yet the impact of these differences on long-term outcomes is unknown. Methods and Results-We linked Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes WithEarly Implementation of American College of Cardiology/American Heart Association Guidelines (CRUSADE) registry data to national Medicare claims, creating a longitudinal record of care and outcomes among 40 500 patients with non-STsegment-elevation myocardial infarction treated at 446 hospitals to examine mortality and readmission rates (mean follow-up, 2.4 years) among black and white patients. Relative to whites (n=37 384), blacks (n=3116) were more often younger and female; more often had diabetes mellitus and renal failure; and received less aggressive interventions, including cardiac catheterization (60.7% versus 54.0%; P<0.001), percutaneous coronary intervention (32.1% versus 23.8%; P<0.001), and coronary bypass surgery (9.2% versus 5.7%; P<0.001). Although blacks had lower 30-day mortality (9.1% versus 9.9%; adjusted hazard ratio, 0.80; 95% confidence interval, 0.71-0.92), they had higher observed mortality at 1 year (27.9% versus 24.5%; P<0.001), although this was not significant after adjustment on long-term follow-up (hazard ratio, 1.00; 95% confidence interval, 0.94-1.07). Black patients also had higher 30-day (23.6% versus 20.0%; P<0.001) and 1-year (62.0% versus 54.6%; P<0.001) all-cause readmission, but these differences were no longer significant after risk adjustment on 30-day (hazard ratio, 1.02; 95% confidence interval, 0.92-1.13) and long-term (hazard ratio, 1.05; 95% confidence interval, 1.00-1.11) follow-up. Conclusions-Although older blacks with an acute myocardial infarction had lower initial mortality rates than whites, this early survival advantage did not persist during long-term follow-up. The reasons for this are multifactorial but may include differences in comorbidities and postdischarge care. Methods Data SourcesThe CRUSADE registry was a voluntary observational data collection and quality-improvement initiative that collected prospective data on patients with non-ST-segment elevation acute coronary syndrome from January 2001 to December 2006. CRUSADE was designed to track guideline adherence, to provide feedback about performance, and to develop quality improvement tools to improve adherence to ACC/AHA recommendations for the treatment of acute coronary syndrome patients. 9 Inclusion and exclusion criteria, data collection, and variables have previously been described. 9 The individual institutional review board of each reporting hospital approved participation in CRUSADE. All data were abstracted retrospectively and anonymously; therefore, informed consent was not required.The process of linking clinical registry data to CMS administrative data has been described previously.10 Briefly, we used indirect identifiers (ie, site, age, admission and dis...

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Thirty-Day Readmission Rates for Medicare Beneficiaries by Race and Site of Care

Joynt¹

2011

JAMA

646

455

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Context Understanding whether and why there are racial disparities in readmissions has implications for efforts to reduce readmissions. Objective To determine whether black patients have higher odds of readmission than white patients, and if these disparities are related to where black patients receive care. Design Using national Medicare data, we examined 30-day readmissions after hospitalization for acute myocardial infarction (AMI), congestive heart failure (CHF), and pneumonia. We categorized hospitals in the top decile of proportion of black patients as “minority-serving.” We determined the odds of readmission for black patients compared with white patients at minority-serving versus non-minority-serving hospitals. Setting U.S. hospitals. Participants 3.1 million Medicare fee-for-service recipients, discharged in 2006–2008. Intervention None. Main Outcome Measure Risk-adjusted odds of 30-day readmission. Results Overall, black patients had higher readmission rates than white patients (24.8% versus 22.6%, odds ratio [OR] 1.13, 95% confidence interval [CI] 1.11 to 1.14, p<0.001); patients from minority-serving hospitals had higher readmission rates than those from non-minority-serving hospitals (25.5% versus 22.0%, OR 1.23, 95% CI 1.20, 1.27, p<0.001). Among AMI patients, using white patients from non-minority-serving hospitals as our reference group (readmission rate 20.9%), we found that black patients from non-minority-serving hospitals had the highest readmission rate (26.4%, OR 1.20, 95% CI 1.16, 1.23), while white patients from minority-serving hospitals had a 24.6% readmission rate (OR 1.23, 95% CI 1.18, 1.29) and black patients from minority-serving hospitals had a 23.3% readmission rate (OR 1.35, 95% CI 1.28, 1.42, p<0.001 for each); patterns were similar for CHF and pneumonia. The results were unchanged after adjusting for hospital characteristics including markers of caring for poor patients. Conclusions Among elderly Americans, black patients were more likely to be readmitted after hospitalization for three common conditions, a gap that was related to both race and to the site where care was received.

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Short‐ and Long‐Term Mortality after an Acute Illness for Elderly Whites and Blacks

Cited by 41 publications

References 30 publications

Impact of Social Factors on Risk of Readmission or Mortality in Pneumonia and Heart Failure: Systematic Review

Impact of Social Factors on Risk of Readmission or Mortality in Pneumonia and Heart Failure: Systematic Review

Differences in Short-Term Versus Long-Term Outcomes of Older Black Versus White Patients With Myocardial Infarction

Thirty-Day Readmission Rates for Medicare Beneficiaries by Race and Site of Care

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