Risk of death after hospitalization for chronic obstructive pulmonary disease (COPD) is higher in Medicare beneficiaries who are White vs those in other racial/ethnic groups, researchers reported in the Annals of the American Thoracic Society.
Researchers conducted a retrospective cohort study analyzing differences by race and ethnicity in long-term mortality among fee-for-service (FFS) Medicare beneficiaries at least 66 years of age with a hospitalization for COPD exacerbation in 2014.
Participants were continuously enrolled in Medicare for 12 months before and after hospitalization. The primary outcome was mortality due to any cause within 1 year following hospital admission.
A total of 244,624 index COPD hospitalizations were identified in 2014 from 4504 hospitals. Of this group, 85.6% of hospitalizations were from White beneficiaries, 8.1% from Black beneficiaries, 4.2% from Hispanic beneficiaries, and 2.1% from beneficiaries of other race and ethnicity. Black and Hispanic patients had greater Charlson comorbidity scores, a higher risk for being frail, and more COPD-specific admissions compared with White patients.
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Black and Hispanic patients had 22% and 21% lower risk of dying within 1 year of hospitalization for COPD compared to White patients. This difference in survival was greater among women than men
The 1-year mortality was highest for White patients (30.9%), followed by Hispanic patients at 27.2%, Black patients at 27.0%, and those of other race and ethnicity groups at 26.7% (P <.001). In-hospital mortality also was increased in White patients vs Hispanic and Black patients (2.5% vs 2.4% and 2.0%, respectively). The highest in-hospital mortality occurred in participants of other race and ethnicity (2.7%) (P <.001).
Black and Hispanic race and ethnicity were associated with a 13% and 17%, respectively, lower mortality risk within 1 year of hospital admission compared with White race in the initial model (model 0), which adjusted for demographic characteristics including age and sex (Black patient hazard ratio [HR], 0.87; 95% CI, 0.85-0.90; Hispanic patient HR, 0.83; 95% CI, 0.79, 0.86). These differences were increased in model 1, which adjusted for additional clinical characteristics (Black patient HR, 0.75; 95% CI, 0.73-0.78; Hispanic patient HR, 0.76; 95% CI, 0.73, 0.80; other races HR, 0.78; 95% CI, 0.74-0.82).
Further controlling for geographic and socioeconomic factors and taking into account patients’ receipt of postacute care in the fully adjusted model (model 3) did not affect these estimates substantially. In the fully adjusted analyses, within 1 year of COPD hospitalization, Black and Hispanic patients had a reduced mortality risk of 22% and 21%, respectively, vs White patients. Additionally, Black women were 26% less likely to die compared with White women (HR, 0.74; 95% CI, 0.71-0.78), and Black men were 18% less likely to die vs White men in the year posthospitalization (HR, 0.82; 95% CI, 0.79-0.86).
Limitations include the lack of information on patients’ cause of death, and the researchers’ inability to account for patient compliance with respiratory inhalers or smoking cessation. Also, the analyses were limited to fee-for-service Medicare beneficiaries.
“Black and Hispanic patients had 22% and 21% lower risk of dying within 1 year of hospitalization for COPD compared to White patients. This difference in survival was greater among women than men with Black women having a 26% lower risk of dying relative to White women as compared with Black men who had a 18% lower risk of dying relative to White men,” said study authors. “While there continue to be racial disparities in COPD treatment and care, the study highlights the importance of further investigation of identifying protective factors for COPD mortality and for studying hitherto understudied populations,” the investigators added.
