title: Comorbid disease and the effect of race and ethnicity on in-hospital mortality from aspiration pneumonia.
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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: University of Virginia, Charlottesville, VA 22908, USA. mno3p@virginia.edu
authors.forename: M Norman
authors.initials: MN
authors.lastname: Oliver
authors.forename: George J
authors.initials: GJ
authors.lastname: Stukenborg
authors.forename: Douglas P
authors.initials: DP
authors.lastname: Wagner
authors.forename: Frank E
authors.initials: FE
authors.lastname: Harrell
authors.forename: Kerry L
authors.initials: KL
authors.lastname: Kilbridge
authors.forename: Jason A
authors.initials: JA
authors.lastname: Lyman
authors.forename: Jonathan
authors.initials: J
authors.lastname: Einbinder
authors.forename: Alfred F
authors.initials: AF
authors.lastname: Connors
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000453:epidemiology / Q000401:mortality; D002140:California / Q000453:epidemiology; D002423:Cause of Death; D002648:Child; D015897:Comorbidity; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D011015:Pneumonia, Aspiration / Q000453:epidemiology / Q000208:ethnology / Q000401:mortality*; D044469:Racial Groups / Q000706:statistics & numerical data; D014883:Water-Electrolyte Imbalance / Q000453:epidemiology / Q000401:mortality