Racial Variation and In-Hospital Death

Pre-existing clinical impressions notwithstanding, the question of whether the predicted risk of death at admission (or severity of illness) is disparate in white and black populations has not yet been answered. Similarly, whether blacks have a higher hospital mortality rate after adjustment for predicted risk is unknown.

In a retrospective cohort study, Howard examined the discharge medical records of 88,205 patients. Patients were restricted to the diagnoses of acute myocardial infarction, congestive heart failure, obstructive airways disease, gastrointestinal hemorrhage, pneumonia, and stroke admitted to hospitals in northeast Ohio in 1991-1993. Predicted risk of death at admission for each diagnosis was determined using validated multivariable models.

Risk-adjusted mortality rates and predicted risks of death were lower in black patients than in whites; odds of hospital death were lower in blacks for congestive heart failure and obstructive airways disease, in particular. Overall, the adjusted odds of hospital death were 13% lower in blacks. This report suggests that when compared to white patients, the hospital mortality outcome of black patients is as good or better.

Howard G. JAMA 1996;276: 1639-1644.