Use of Mechanical and Noninvasive Ventilation in Black and White Chronic Obstructive Pulmonary Disease Patients Within the Veterans Administration Health Care System

被引:13
作者
Cannon, Katrina T. [1 ,3 ]
Sarrazin, Mary Vaughan [1 ,3 ]
Rosenthal, Gary E. [1 ,3 ]
Curtis, Ann E. [1 ,3 ]
Thomas, Karl W. [2 ,4 ]
Kaldjian, Lauris C. [1 ,3 ,5 ]
机构
[1] Iowa City VA Med Ctr, CRIISP, Iowa City, IA USA
[2] Iowa City VA Med Ctr, Dept Primary & Special Med, Iowa City, IA USA
[3] Univ Iowa, Carver Coll Med, Div Gen Internal Med, Iowa City, IA USA
[4] Univ Iowa, Carver Coll Med, Div Pulm Crit Care & Occupat Med, Iowa City, IA USA
[5] Univ Iowa, Carver Coll Med, Program Bioeth & Humanities, Iowa City, IA USA
关键词
African American; COPD; end of life; health disparities; health services research; LIFE-SUSTAINING TREATMENTS; ACUTE RESPIRATORY-FAILURE; NURSING-HOME RESIDENTS; DUAL-USE; END; ATTITUDES; RACE; PREFERENCES; INPATIENT; ETHNICITY;
D O I
10.1097/MLR.0b013e3181809150
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Background: Black patients are more likely than white patients to prefer and receive more life-sustaining interventions in advance stages of disease. However, little is known about potential racial differences in use of mechanical ventilation (MV), and the newer modality of noninvasive ventilation (NIV), in,treatment of chronic obstructive Pulmonary disease (COPD). Objective: To determine if rates of MV and NIV use differ among black and white patients admitted to Veterans Administration (VA) hospitals for COPD, exacerbation. Research Design: Retrospective cohort analysis of VA database FY2003 to FY2005 including 153 hospitals nationwide. Subjects: All black (n = 5479) and white (n = 31,537 patients admitted with COPD exacerbation. Measures: Ventilation use during hospitalization as identified by ICD-9-CM codes for MV and NIV. Hierarchical logistic regression compared rates of MV or NIV use among black and white patients, adjusting for patient characteristics and accounting for hospital-level variation. Results: Unadjusted rates of MV were higher in black patients than in white patients (4.1% vs. 3.0%; P < 0.001), but similar for NIV (6.0% vs. 6.1%; P = 0.65). The adjusted odds of MV for black patients relative to white patients remained higher (OR = 1.27, 95% CI: 1.01-1.54; P < 0.01) while the adjusted odds of NIV remained similar (OR = 0.94, 95% CI: 0.82-1.08; P = 0.38). Conclusions: Black patients with COPD, exacerbation in VA hospitals are more likely than white patients to receive MV, and this difference is not explained by available clinical or demographic variables. By contrast, black and white patients are equally likely to receive NIV. These findings suggest that unmeasured factors, such as patient preferences or disease severity, may be affecting the use of MV in this setting and therefore warrant further investigation.
引用
收藏
页码:129 / 133
页数:5
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