title: Disparity of risk-adjusted inpatient outcomes among African American and white patients hospitalized with community-acquired pneumonia.
abstract: The objectives of this study were to examine the associations between inpatient pneumonia outcomes, health care factors, and sociodemographics with an emphasis on race. African American and white patients from the 2008 National Hospital Discharge Survey who were admitted to nonprofit and for-profit hospitals with a principal diagnosis of pneumonia were sampled (n=1924). Three outcomes were measured: length of hospital stay, discharge to home, and deceased at discharge. Length of hospital stay was measured with negative binomial regression including incidence rate ratios (IRRs), while the remaining 2 outcomes were measured with logistic regression including odds ratios (ORs). Patients with longer hospital stays relative to peers were likely older (IRR=1.01, 95% confidence interval [CI]=1.01-1.01, P<0.001) and African American (IRR=1.19, 95% CI=1.10-1.30, P<0.001), but had fewer comorbidities (IRR=0.97, 95% CI=0.94-0.99, P=0.016). Patients were less likely to be discharged to home if they were older (OR=0.96, 95% CI=0.95-0.96, P<0.001), African American (OR=0.68, 95% CI=0.52-0.90, P=0.006), and had government insurance (OR=0.59, 95% CI=0.44-0.79, P<0.001). Patients deceased at discharge were more likely to be older (OR=1.03, 95% CI=1.01-1.05, P=0.001), African American (OR=1.97, 95% CI=1.10-3.53, P=0.023), and to have fewer comorbidities (OR=0.71, 95% CI=0.57-0.88, P=0.002). African Americans with pneumonia experience inequitable inpatient pneumonia-related outcomes relative to whites. Hospital interventions addressing equity are needed.
authors.affiliation: Department of Health Policy and Management, School of Rural Public Health, Texas A&M Health Science Center , College Station, Texas 77843, USA. dickerson@srph.tamhsc.edu
authors.forename: Justin B
authors.initials: JB
authors.lastname: Dickerson
authors.forename: Matthew Lee
authors.initials: ML
authors.lastname: Smith
mesh_terms: D001741:Black or African American; D017714:Community-Acquired Infections; D006293:Health Promotion; D006760:Hospitalization; D006801:Humans; D008922:Mississippi / Q000453:epidemiology; D011014:Pneumonia / Q000191:economics; D011236:Prediabetic State / Q000453:epidemiology