2010. Effects of Ethnicity on
One Year Mortality in Seriously Ill Veteran Population
SM Fischer, Denver VAMC and University of Colorado Health Sciences
Center, AS Sauaia, University of Colorado Health Sciences Center, A
Kramer, University of Colorado Health Sciences Center
Objectives: Despite
national efforts to reduce health disparities, the inequalities in care and
health outcomes for ethnic minorities continue to grow. Studies in the VA system
have demonstrated that despite equal access and care, African Americans present
with more advanced disease and have higher all cause mortality. o our knowledge,
there have been no similar studies including Latinos. This study was designed to
determine whether Latino and African American ethnicity is an independent
predictor of one-year mortality following an index hospitalization.
Methods: Study Design: A
retrospective cohort study to determine the independent effect of Latino and
African American ethnicity (defined as phenotypic appearance as recorded in the
medical record) on a logistic regression predictive model including the CARING
criteria (Cancer, Admissions > = 2, Residence in a nursing home, ICU admit
with MOF, > = 2 Non-cancer
hospice Guidelines).These criteria were developed and validated in a population
of seriously ill hospitalized Veterans to predict one-year mortality. Mortality
was also adjusted for age. Sex was not included in the model because 98% of
patients were men. Setting: Denver Veterans’ Administration Medical Center (DVAMC).
Patients: All patients admitted to the medical wards from February 1, 1999
through March 31, 1999 (n = 435).
Results: The study
population included 9% Latinos and 13% African Americans, while Denver’s
overall population is 20% Latino and 5% African American. Forty-seven percent of
the hospitalized Veterans met at least one of the CARING criteria. Latino
ethnicity and each CARING criteria were significant predictors of mortality in
unadjusted chi-square tests. Latino ethnicity had an independent effect on
one-year mortality when this variable was entered into a predictive model with
an adjusted odds ratio of 2.5 (95% CI 1.1 – 5.7). Adjusted mortality was not
higher among African Americans (adjusted odds ratio 0.8 (95% CI 0.3 – 1.9).
Conclusions: Latino but
not African American ethnicity had an independent effect on one-year mortality
for hospitalized seriously ill adults in an equal access system.
Impact: Latino but not African American ethnicity had an independent effect on one-year mortality for hospitalized seriously ill adults in an equal access system.