Hospital characteristics and racial disparities in hospital mortality from common medical conditions.
OBJECTIVE
Less is known about racial disparities in mortality from medical conditions than for procedures. We determined whether black-white disparities in risk-adjusted hospital mortality exist for five common conditions (myocardial infarction, congestive heart failure, cerebral vascular accident, gastrointestinal hemorrhage and pneumonia), and to determine the role of hospital characteristics.


METHODS
We used the 2003 Nationwide Inpatient Sample. Where a mortality disadvantage for black patients was demonstrated, additional analyses assessed whether the degree of disparity varied by hospital characteristics.


RESULTS
Mortality for black patients was equivalent to or lower than that for white patients for four of the five conditions. Black patients were more likely than white patients to die from gastrointestinal hemorrhage (1.5% vs. 1.1%, p<0.001). In multivariate analysis, hospital racial composition was the only characteristic associated with degree of disparity for gastrointestinal hemorrhage, with hospitals discharging fewer black patients demonstrating greater disparity.


CONCLUSIONS
In a large, multistate sample, there was no evidence of disparities in mortality for four of five common conditions. Black-white racial disparities in mortality from gastrointestinal hemorrhage, however, may be associated with hospital racial composition.
Pippins
Jennifer R
JR
Division of General Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
Fitzmaurice
Garrett M
GM
Haas
Jennifer S
JS
D001741:Black or African American / Q000706:statistics & numerical data*; D002318:Cardiovascular Diseases / Q000208:ethnology / Q000401:mortality; D019538:Health Care Surveys; D017052:Hospital Mortality / Q000639:trends*; D006761:Hospitals / Q000592:standards*; D006801:Humans; D010351:Patient Discharge / Q000706:statistics & numerical data; D010865:Pilot Projects; D011014:Pneumonia / Q000208:ethnology / Q000401:mortality; D016012:Poisson Distribution; D044469:Racial Groups; D018570:Risk Assessment; D012307:Risk Factors; D012923:Social Class; D012935:Social Justice; D014481:United States / Q000453:epidemiology