White Medicare beneficiaries face elevated mortality risk after COPD hospitalization

Key takeaways:

• The risk for mortality after COPD hospitalization was reduced among Black and Hispanic patients vs. white patients.
• In dual-eligible patients, post-acute care factors attenuated part of this gap.

Among Medicare beneficiaries hospitalized for a COPD exacerbation, the risk for mortality within 1 year was higher in white patients vs. Black or Hispanic patients, according to results published in Annals of the American Thoracic Society.

“Our findings highlight that Medicare beneficiaries who identify as white are at risk for higher mortality up to a year following COPD hospitalization,” Snigdha Jain, MD, MHS, assistant professor of pulmonary, critical care and sleep medicine at Yale School of Medicine, and colleagues wrote.

In a retrospective cohort study, Jain and colleagues analyzed 244,624 hospitalizations for a COPD exacerbation in 2014 among Medicare beneficiaries aged 66 years or older (mean age, 76.9 years; 58% women) to find out if race and ethnicity are related to mortality within 1 year of hospitalization.

Researchers adjusted for clinical, geographic, socioeconomic and post-acute care factors in Cox regression models to find this relationship and then assessed whether these factors influenced the mortality difference between the racial and ethnic groups.

White beneficiaries were behind most of these hospitalizations (85.6%), followed by Black beneficiaries (8.1%), Hispanic beneficiaries (4.2%) and beneficiaries of other races and ethnicities (2.1%).

Compared with racial and ethnic minority groups, more white patients died within 1 year of COPD hospitalization (30.9% vs. Hispanic patients, 27.2% vs. Black patients, 27% vs. other race and ethnicity groups, 26.7%).

In-hospital mortality rates between patient groups slightly differed from the 1-year mortality rates because more patients of other race and ethnicity died in the hospital than white patients, Black patients and Hispanic patients (2.7% vs. 2.5% vs. 2% vs. 2.4%).

Once adjusted for all the factors outlined above, researchers found that the 1-year mortality risk was reduced among Black patients (adjusted HR = 0.78; 95% CI, 0.75-0.8), Hispanic patients (aHR = 0.79; 95% CI, 0.76-0.82) and patients of other racial and ethnic minorities (aHR = 0.82; 95% CI, 0.77-0.86) vs. white patients.

Between Black women and white women, Black women had a lower risk for 1-year mortality (aHR = 0.74; 95% CI, 0.71-0.78). Among men, the likelihood for death was reduced by 18% (aHR = 0.82; 95% CI, 0.79-0.86) in Black vs. white men.

Researchers did not find an explanation for the mortality difference between the racial and ethnic groups when evaluating geographic, neighborhood socioeconomic or post-acute care characteristics.

Of the total cohort, 26.2% of patients had dual eligibility.

In this population, the mortality gap between white patients and patients of racial and ethnic minority groups moved toward leveling out after researchers adjusted for neighborhood and post-acute care factors (model 3) compared with only adjusting for clinical characteristics (model 1). Between these two models, the hazard ratio for 1-year mortality went from 0.74 to 0.8 among Black patients, 0.69 to 0.77 among Hispanic patients and 0.72 to 0.78 among other race and ethnicity groups.

Notably, differences in three factors clarified “some of the mortality gap” between the groups: visits to physicians, pulmonary rehabilitation attendance and disposition discharge. According to researchers, these factors did not explain gaps among non-dual-eligible individuals.

“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 to better understand racial differences in diagnoses and access to outpatient, emergency department, in-hospital and post-hospitalization care,” Jain and colleagues wrote. “In addition, understanding the impact of socioeconomic status, environment and within group differences among racial-ethnic groups may aid in reducing COPD mortality overall.”