title: Sex, race, and the development of acute lung injury.
abstract: BACKGROUND
  Prior studies suggest that mortality differs by sex and race in patients who develop acute lung injury (ALI). Whether differences in presentation account for these disparities remains unclear. We sought to determine whether sexual and racial differences exist in the rate of ALI development and ALI-related mortality after accounting for differences in clinical presentations.
  
  
  METHODS
  This was a multicenter, observational cohort study of 5,201 patients at risk for ALI. Multivariable logistic regression with adjustment for center-level effects was used to adjust for potential covariates.
  
  
  RESULTS
  The incidence of ALI development was 5.9%; in-hospital mortality was 5.0% for the entire cohort, and 24.4% for those patients who developed ALI. Men were more likely to develop ALI compared to women (6.9% vs 4.7%, P , .001) and had a nonsignificant increase in mortality when ALI developed (27.6% vs 18.5%, P 5 .08). However, after adjustment for baseline imbalances between sexes these differences were no longer significant. Black patients, compared to white patients, presented more frequently with pneumonia, sepsis, or shock and had higher severity of illness. Black patients were less likely to develop ALI than whites (4.5% vs. 6.5%, P 5 .014), and this association remained statistically significant after adjusting for differences in presentation (OR, 0.66; 95 % CI, 0.45-0.96).
  
  
  CONCLUSIONS
  Sex and race differences exist in the clinical presentation of patients at risk of developing ALI. After accounting for differences in presentation, there was no sex difference in ALI development and outcome. Black patients were less likely to develop ALI despite increased severity of illness on presentation.
authors.affiliation: Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY.
authors.forename: Luciano B
authors.initials: LB
authors.lastname: Lemos-Filho
authors.affiliation: Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
authors.forename: Mark E
authors.initials: ME
authors.lastname: Mikkelsen
authors.affiliation: Emory University, Atlanta, GA.
authors.forename: Greg S
authors.initials: GS
authors.lastname: Martin
authors.affiliation: University of Missouri, Columbia, MO.
authors.forename: Ousama
authors.initials: O
authors.lastname: Dabbagh
authors.affiliation: University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Adebola
authors.initials: A
authors.lastname: Adesanya
authors.affiliation: Temple University School of Medicine, Philadelphia, PA.
authors.forename: Nina
authors.initials: N
authors.lastname: Gentile
authors.affiliation: Emory University, Atlanta, GA.
authors.forename: Annette
authors.initials: A
authors.lastname: Esper
authors.affiliation: Mayo Clinic, Rochester, MN.
authors.forename: Ognjen
authors.initials: O
authors.lastname: Gajic
authors.affiliation: Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY. Electronic address: mgong@montefiore.org.
authors.forename: Michelle N
authors.initials: MN
authors.lastname: Gong
mesh_terms: D055371:Acute Lung Injury / Q000453:epidemiology* / Q000208:ethnology / Q000401:mortality*; D000328:Adult; D000368:Aged; D044466:Asian People / Q000208:ethnology; D044383:Black People / Q000208:ethnology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D044469:Racial Groups; D012737:Sex Factors; D015996:Survival Rate; D044465:White People / Q000208:ethnology