Short- and long-term mortality after an acute illness for elderly whites and blacks.
OBJECTIVE
To estimate racial differences in mortality at 30 days and up to 2 years following a hospital admission for the elderly with common medical conditions.


METHODS
The Medicare Provider Analysis and Review File and the VA Patient Treatment File from 1998 to 2002 were used to extract patients 65 or older admitted with a principal diagnosis of acute myocardial infarction, stroke, hip fracture, gastrointestinal bleeding, congestive heart failure, or pneumonia.


METHODS
A retrospective analysis of risk-adjusted mortality after hospital admission for blacks and whites by medical condition and in different hospital settings.


RESULTS
Black Medicare patients had consistently lower adjusted 30-day mortality than white Medicare patients, but the initial survival advantage observed among blacks dissipated beyond 30 days and reversed by 2 years. For VA hospitalizations similar patterns were observed, but the initial survival advantage for blacks dissipated at a slower rate.


CONCLUSIONS
Racial disparities in health are more likely to be generated in the posthospital phase of the process of care delivery rather than during the hospital stay. The slower rate of increase in relative mortality among black VA patients suggests an integrated health care delivery system like the VA may attenuate racial disparities in health.
Polsky
Daniel
D
VA Center for Health Equity Research and Promotion, Department of General Internal Medicine, University of Pennsylvania School of Medicine, Wharton School, University of Pennsylvania, Philadelphia, PA 19104, USA. polsky@mail.med.upenn.edu
Jha
Ashish K
AK
Lave
Judith
J
Pauly
Mark V
MV
Cen
Liyi
L
Klusaritz
Heather
H
Chen
Zhen
Z
Volpp
Kevin G
KG
D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000401:mortality; D006333:Heart Failure / Q000401:mortality; D006620:Hip Fractures / Q000401:mortality; D017052:Hospital Mortality / Q000208:ethnology*; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D009203:Myocardial Infarction / Q000401:mortality; D011014:Pneumonia / Q000401:mortality; D012189:Retrospective Studies; D020521:Stroke / Q000401:mortality; D016019:Survival Analysis; D017741:Survivors / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*