Racial and ethnic disparities in mortality from acute lung injury

Objective: Little is known about the influence of race and ethnicity on mortality from acute lung injury (ALI). We sought to determine whether black race or Hispanic ethnicity is independently associated with mortality among patients with ALI. Design: Retrospective cohort study of patients enrolled in the Acute Respiratory Distress Syndrome Network randomized controlled trials. Setting: Adult intensive care units participating in the Acute Respiratory Distress Syndrome Network trials. Patients: A total of 2362 mechanically ventilated patients (11715 white, 449 black, and 198 Hispanic) with ALI. Measurements and Main Results. The primary outcome was 60-day mortality. A secondary outcome was number of ventilator-free days. Crude mortality was 33% for both blacks and Hispanics compared with 27% for whites (p = 0.02). After adjusting for demographic and clinical covariates, the association between race/ethnicity and mortality persisted (odds ratio [OR] = 1.42; 95% confidence interval [CI] 1.10-1.84 for blacks; OR = 1.94; 95% Cl, 1.36-2.77 for Hispanics; OR = 1.00 for whites). After adjustment for severity of illness (Acute Physiology Score), black race was no longer significantly associated with mortality (OR = 1.25; 95% Cl, 0.95-1.66), whereas the association with Hispanic ethnicity persisted (OR = 2.00; 95% Cl, 1.37-2.90). Hispanics had significantly fewer ventilator-free days compared with whites after adjustment for demographic and clinical covariates (mean difference in days = -2.3; 95% Cl -3.90 to -0.70). Conclusions. Black and Hispanic patients with ALI have a significantly higher risk of death compared with white patients. This increased risk seemed to be mediated by increased severity of illness at presentation for blacks, but was unexplained among Hispanics. (Grit Care Med 2009; 37:1-6)