Racial variation in predicted and observed in-hospital death. A regional analysis.
OBJECTIVE
To compare observed, predicted, and risk-adjusted hospital mortality rates in white and African-American patients and to determine whether, as prior studies suggest, African-American patients would have higher predicted risks of death and similar or higher risk-adjusted mortality.


METHODS
Retrospective cohort study.


METHODS
Thirty hospitals in northeast Ohio.


METHODS
A total of 88205 eligible patients consecutively discharged in the years 1991 through 1993 with the following 6 diagnoses: acute myocardial infarction, congestive heart failure, obstructive airways disease, gastrointestinal hemorrhage, pneumonia, and stroke.


METHODS
We measured predicted risks of death at admission for each diagnosis using validated multivariable models based on standard clinical data abstracted from patients' medical records. We then adjusted in-hospital mortality rates in white and African-American patients for predicted risk of death and other covariates using logistic regression analysis.


METHODS
Predicted risk of death at admission and observed hospital mortality in white and African-American patients.


RESULTS
Predicted risks of death were lower (P<.001) in African Americans for 4 of the 6 diagnoses. Adjusted odds of hospital death were lower (P<.01) in African Americans for 2 of the 6 diagnoses (congestive heart failure and obstructive airways disease) and similar for the other 4 diagnoses. For all diagnoses, in aggregate, the adjusted odds of hospital death were 13% lower in African-American compared with white patients (multivariable odds ratio, 0.87; 95% confidence interval, 0.80-0.94). Findings were similar if further adjustments were made for differences in length of stay, site of hospitalization, or discharge triage practices.


CONCLUSIONS
Contrary to our a priori hypotheses, predicted risks of death and risk-adjusted mortality rates were generally lower in African-American patients. Our finding of lower predicted risk may reflect racial differences in hospital admission practices or in access to outpatient care. However, our findings suggest that, once hospitalized, African-American patients attained similar or better outcomes, as measured by an important measure--hospital mortality.
Gordon
H S
HS
Program in Health Care Research, Division of General Internal Medicine, Cleveland Veterans Affairs Medical Center, OH 44106, USA.
Harper
D L
DL
Rosenthal
G E
GE
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D002561:Cerebrovascular Disorders / Q000208:ethnology / Q000401:mortality; D015331:Cohort Studies; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000208:ethnology / Q000401:mortality; D006333:Heart Failure / Q000208:ethnology / Q000401:mortality; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008173:Lung Diseases, Obstructive / Q000208:ethnology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000208:ethnology / Q000401:mortality; D011014:Pneumonia / Q000208:ethnology / Q000401:mortality; D017064:Process Assessment, Health Care; D012189:Retrospective Studies; D012306:Risk; D014481:United States; D044465:White People / Q000706:statistics & numerical data