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Are There Racial Differences in Inpatient Outcomes and Treatment Utilization following Hospitalization for Myasthenia
Maryam J Syed1, Ayaz Khawaja1, Robert P Lisak1,2
1Department of Neurology, Wayne State University School of Medicine, Detroit, Michigan, USA.
Introduction:
Little is known about racial differences in inpatient outcomes following hospitalizations for myasthenia gravis (MG). In this study, we used a claims-based database to assess racial differences in outcomes in hospitalized myasthenics.
Methods:
The 2006-2014 National Inpatient Sample database was queried using the International Classification of Diseases 9th Edition diagnosis code (358.01) to identify adult patients (age >17 years) undergoing hospitalization for MG. Race was categorized into - white, black/African American (AA), Asian or Pacific Islander, Hispanic, Native American, and other. Complications assessed included urinary tract infections, acute renal failure, cardiac complications, systemic infection, deep venous thrombosis, and pulmonary embolism. Multivariate logistic regression analyses were used to assess whether race was associated with a difference in outcomes, after controlling for baseline demographics, hospital characteristics, and treatment factors.
Results:
A total of 56,189 patient admissions, using a weighted sample, underwent hospitalization for MG between 2006 and 2014. Black/AA patients had significantly higher odds of experiencing systemic infections (odds ratio [OR] 1.35 [95% confidence intervals [CI] 1.16-1.58]; p < 0.001), deep venous thrombosis (OR 2.11 [95% CI 1.36-3.27]; p = 0.001), and renal failure (OR 1.19 [95% CI 1.05-1.35]; p = 0.005). Black/AA patients were more likely to be intubated (OR 1.09 [95% CI 1.01-1.19]; p = 0.028) and receive noninvasive mechanical ventilation (OR 1.62 [95% CI 1.46-1.79]; p < 0.001), however, were less likely to receive intravenous immunoglobulin (OR 0.77 [95% CI 0.73-0.82]; p < 0.001) and plasmapheresis (OR 0.77 [95% CI 0.72-0.82]; p < 0.001). Black/AA and Hispanic patients had lower mortality (OR 0.74 [95% CI 0.59-0.94; p = 0.012].
Conclusions:
Significant racial differences exist in both treatment utilization and inpatient outcomes for patients hospitalized for MG.
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