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dc.creatorFrei, Christopher R.en_US
dc.creatorMortensen, Eric M.en_US
dc.creatorCopeland, Laurel A.en_US
dc.creatorAttridge, Russell T.en_US
dc.creatorPugh, Mary Jo V.en_US
dc.creatorRestrepo, Marcos I.en_US
dc.creatorAnzueto, Antonioen_US
dc.creatorNakashima, Brandyen_US
dc.creatorFine, Michael J.en_US
dc.date.accessioned2016-10-28T19:53:49Z
dc.date.available2016-10-28T19:53:49Z
dc.date.issued2010-05en_US
dc.identifierdoi:10.15781/T2VM43094
dc.identifier.citationFrei, Christopher R., Eric M. Mortensen, Laurel A. Copeland, Russell T. Attridge, Mary Pugh, Marcos I. Restrepo, Antonio Anzueto, Brandy Nakashima, and Michael J. Fine. "Disparities of care for African-Americans and Caucasians with community-acquired pneumonia: a retrospective cohort study." BMC health services research, Vol. 10, No. 1 (May, 2010): 1.en_US
dc.identifier.issn1472-6963en_US
dc.identifier.urihttp://hdl.handle.net/2152/43363
dc.description.abstractAfrican-Americans admitted to U.S. hospitals with community-acquired pneumonia (CAP) are more likely than Caucasians to experience prolonged hospital length of stay (LOS), possibly due to either differential treatment decisions or patient characteristics. Methods: We assessed associations between race and outcomes (Intensive Care Unit [ICU] variables, LOS, 30-day mortality) for African-American or Caucasian patients over 65 years hospitalized in the Veterans Health Administration (VHA) with CAP (2002-2007). Patients admitted to the ICU were analyzed separately from those not admitted to the ICU. VHA patients who died within 30 days of discharge were excluded from all LOS analyses. We used chi-square and Fisher's exact statistics to compare dichotomous variables, the Wilcoxon Rank Sum test to compare age by race, and Cox Proportional Hazards Regression to analyze hospital LOS. We used separate generalized linear mixed-effect models, with admitting hospital as a random effect, to examine associations between patient race and the receipt of guideline-concordant antibiotics, ICU admission, use of mechanical ventilation, use of vasopressors, LOS, and 30-day mortality. We defined statistical significance as a two-tailed p <= 0.0001. Results: Of 40,878 patients, African-Americans (n = 4,936) were less likely to be married and more likely to have a substance use disorder, neoplastic disease, renal disease, or diabetes compared to Caucasians. African-Americans and Caucasians were equally likely to receive guideline-concordant antibiotics (92% versus 93%, adjusted OR = 0.99; 95% CI = 0.81 to 1.20) and experienced similar 30-day mortality when treated in medical wards (adjusted OR = 0.98; 95% CI = 0.87 to 1.10). African-Americans had a shorter adjusted hospital LOS (adjusted HR = 0.95; 95% CI = 0.92 to 0.98). When admitted to the ICU, African Americans were as likely as Caucasians to receive guideline-concordant antibiotics (76% versus 78%, adjusted OR = 0.99; 95% CI = 0.81 to 1.20), but experienced lower 30-day mortality (adjusted OR = 0.82; 95% CI = 0.68 to 0.99) and shorter hospital LOS (adjusted HR = 0.84; 95% CI = 0.76 to 0.93). Conclusions: Elderly African-American CAP patients experienced a survival advantage (i.e., lower 30-day mortality) in the ICU compared to Caucasians and shorter hospital LOS in both medical wards and ICUs, after adjusting for numerous baseline differences in patient characteristics. There were no racial differences in receipt of guideline-concordant antibiotic therapies.en_US
dc.description.sponsorshipNational Institute of Nursing Research R01NR010828en_US
dc.language.isoEnglishen_US
dc.relation.ispartofen_US
dc.rightsAdministrative deposit of works to Texas ScholarWorks: This works author(s) is or was a University faculty member, student or staff member; this article is already available through open access or the publisher allows a PDF version of the article to be freely posted online. The library makes the deposit as a matter of fair use (for scholarly, educational, and research purposes), and to preserve the work and further secure public access to the works of the University.en_US
dc.subjectof-veterans-affairsen_US
dc.subjectempiric antibiotic-therapyen_US
dc.subjectunited-statesen_US
dc.subjectantimicrobial therapyen_US
dc.subjectadministrative dataen_US
dc.subjectracial-differencesen_US
dc.subjectelderly-patientsen_US
dc.subjecthospital mortalityen_US
dc.subjectpulmonary-diseaseen_US
dc.subjectimpacten_US
dc.subjecthealth care sciences & servicesen_US
dc.titleDisparities of Care for African-Americans and Caucasians with Community-Acquired Pneumonia: A Retrospective Cohort Studyen_US
dc.typeArticleen_US
dc.description.departmentPharmacyen_US
dc.rights.restrictionOpenen_US
dc.identifier.doi10.1186/1472-6963-10-143en_US
dc.contributor.utaustinauthorFrei, Christopher R.en_US
dc.contributor.utaustinauthorAttridge, Russell T.en_US
dc.relation.ispartofserialBMC Health Services Researchen_US


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