Racial Differences in 1-Year Mortality after Hospitalization for Chronic Obstructive Pulmonary Disease in the United States.

Publisher: American Thoracic Society Country of Publication: United States NLM ID: 101600811 Publication Model: Print Cited Medium: Internet ISSN: 2325-6621 (Electronic) Linking ISSN: 23256621 NLM ISO Abbreviation: Ann Am Thorac Soc Subsets: MEDLINE

Original Publication: New York, NY : American Thoracic Society, [2013]-

Ethnicity* ; Pulmonary Disease, Chronic Obstructive*/epidemiology; Humans ; Aged ; United States/epidemiology ; Retrospective Studies ; Race Factors ; Minority Groups ; Medicare ; Hospitalization

Rationale: One quarter of Medicare beneficiaries hospitalized for chronic obstructive pulmonary disease (COPD) die within 1 year. Although overall mortality rates are higher among White patients with COPD, racial and ethnic differences in the vulnerable period following hospitalization are unknown. Objectives: To determine the association between race and ethnicity and mortality following COPD hospitalization and to evaluate the extent to which differences are explained by clinical, geographic, socioeconomic, and post-acute care factors among Medicare beneficiaries in the United States. Methods: In this retrospective cohort study of Medicare beneficiaries hospitalized for COPD exacerbation, we constructed Cox regression models for 1-year mortality accounting for hospital-level clustering; sequentially adjusting for clinical, geographic, neighborhood socioeconomic, and post-acute care characteristics; and stratifying by sex and individual socioeconomic status. Results: Among 244,624 hospitalizations, Medicare beneficiaries of racial and ethnic minority groups had a lower risk of dying within 1 year of hospitalization than those of White race (hazard ratios, 0.78 [95% confidence interval, 0.75-0.80] for Black patients, 0.79 [0.76-0.82] for Hispanic patients, and 0.82 [0.77-0.86] for others). Differences in visits to physicians, attendance of pulmonary rehabilitation, and discharge disposition explained some of the mortality gap among dual-eligible beneficiaries but not among non-dual-eligible beneficiaries. Conclusions: Medicare beneficiaries of White race are at greater risk of mortality following COPD hospitalization compared with beneficiaries of minority race and ethnicity groups. Our findings should be interpreted in the context of the selection of a hospitalized population and a potentially incomplete assessment of illness severity in administrative data, and warrant further investigation.

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R03 AG078942 United States AG NIA NIH HHS; K24HL132008 United States HL NHLBI NIH HHS; P30 AG021342 United States AG NIA NIH HHS; R01 HL139751 United States HL NHLBI NIH HHS; L60 DA054692 United States DA NIDA NIH HHS; R01 HL151607 United States HL NHLBI NIH HHS; P30AG021342 United States AG NIA NIH HHS; DP5 OD029636 United States OD NIH HHS; R01 HL136660 United States HL NHLBI NIH HHS; DP1 DA058982 United States DA NIDA NIH HHS; OT2 HL156812 United States HL NHLBI NIH HHS; K24 HL132008 United States HL NHLBI NIH HHS

Keywords: chronic obstructive pulmonary disease; health disparities; post-hospitalization mortality; race and ethnicity

Date Created: 20231109 Date Completed: 20240403 Latest Revision: 20240505

20240505

PMC10995557

10.1513/AnnalsATS.202304-359OC

37943953