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Racial/Ethnic Differences in 30-Day Mortality for Heart Failure and Pneumonia in the Veterans Health Administration
Gabriella C Silva1, Lan Jiang2, Roee Gutman1
1Department of Biostatistics, Brown University School of Public Health.
Medical Care
|November 15, 2021
Summary
Black Veterans had lower mortality and Hispanic Veterans had higher mortality for heart failure and pneumonia compared to White Veterans. Clinical variables significantly impacted these observed racial/ethnic differences in mortality.
Area of Science:
- Health Services Research
- Clinical Epidemiology
- Health Disparities Research
Background:
- Previous research indicated lower mortality in Black Veterans versus White Veterans for common conditions, but relied on administrative claims for comorbidity adjustment.
- This study addresses limitations of prior work by examining racial/ethnic mortality differences in heart failure and pneumonia hospitalizations.
Purpose of the Study:
- To compare 30-day all-cause mortality for non-Hispanic White, Black, and Hispanic Veterans hospitalized for heart failure (HF) and pneumonia.
- To determine how risk-adjustment models influence observed racial/ethnic mortality disparities by including claims-based and clinical variables.
Main Methods:
- Observational study of 143,520 heart failure and 127,782 pneumonia admissions across 132 VA Medical Centers (2009-2015).
- Logistic regression models estimated average marginal effects (AME) for Black and Hispanic Veterans relative to White Veterans, incorporating claims-based, clinical, and sociodemographic variables.
Main Results:
- Unadjusted 30-day mortality rates for HF/pneumonia were: White (7.2%/11.0%), Black (4.1%/10.4%), Hispanic (8.4%/16.9%).
- After risk adjustment, Black Veterans consistently showed lower mortality, and Hispanic Veterans higher mortality, compared to White Veterans for both conditions.
- Including clinical variables in risk-adjustment models altered the magnitude of these racial/ethnic mortality differences.
Conclusions:
- Black Veterans experienced lower mortality, while Hispanic Veterans faced higher mortality post-hospitalization for HF and pneumonia relative to White Veterans.
- The inclusion of clinical variables in risk-adjustment models is crucial for accurately assessing racial/ethnic disparities in mortality.
- Future research on health disparities should incorporate clinical data for robust risk adjustment.