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Racial disparities in quality of care in community-acquired pneumonia

Introduction

In population-based studies, blacks had higher risk of severe sepsis and mortality compared with whites, but the reasons for these differences are unknown. We examined racial differences in quality of care and outcomes in subjects hospitalized with community-acquired pneumonia (CAP).

Methods

We analyzed 352 blacks and 1,738 whites enrolled in an observational cohort study of subjects with CAP. We used Medicare and American Thoracic Society (ATS) guidelines to assess the quality of care, comparing timing of initial antibiotics and whether initial antibiotic therapy was compliant with ATS guidelines.

Results

Whites were older than blacks (mean age 68 years vs 53 years, P < 0.0001), had a higher burden of chronic disease (69.2% vs 63.1% Charlson score > 0, P = 0.02), and had higher severity of illness (mean APACHE III score 53.9 vs 47.4, P < 0.001; mean Pneumonia Severity Index (PSI) 97.7 vs 78.6, P < 0.0001). Blacks were more likely to go to large (>500 beds) teaching hospitals (87.5% vs 46.4%, P < 0.0001 went to teaching hospitals, and 37.6% vs 10.5%, P < 0.0001 went to large hospitals). Blacks were less likely to receive ATS-guideline compliant antibiotics and less likely to receive antibiotics within 4 hours (Figure 1). These differences persisted when analyses were stratified by PSI class, but were not significant in multivariable analyses with hospital characteristics as random effects to account for clustering of racial groups. No differences were seen in risk of severe sepsis and 90-day mortality.

Figure 1
figure1

Racial disparities in quality of care.

Conclusion

Blacks receive lower quality of care when hospitalized for CAP.

Acknowledgements

Supported by T32HL00782010 and R01GM61992.

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Mayr, F., Yende, S., Milbrandt, E. et al. Racial disparities in quality of care in community-acquired pneumonia. Crit Care 12, P424 (2008). https://doi.org/10.1186/cc6645

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Keywords

  • Pneumonia
  • Severe Sepsis
  • Teaching Hospital
  • Multivariable Analysis
  • Racial Difference