Greater hospital racial diversity linked to poorer mechanical ventilation outcomes

Key takeaways:

• Patients receiving mechanical ventilation for pneumonia or sepsis at racially diverse hospitals had higher risk-adjusted mortality.
• Black women experienced higher risk-adjusted mortality than white men.

SAN DIEGO — Patients ventilated for pneumonia or sepsis faced higher mortality odds as the racial diversity of the patient population increased, according to a poster presented at the American Thoracic Society International Conference.

“For this study, we hypothesized that hospitals that take care of a more diverse population would have hospital systems and processes of care that would result in smaller differences in mortality between groups,” Gwenyth Day, MD, third-year fellow in the division of pulmonary sciences and critical care medicine at University of Colorado Anschutz Medical Campus, told Healio. “Interestingly, our data showed that the odds of death for female Black patients compared with male white patients was higher in most quartiles of hospital diversity, but that the odds of mortality did not increase significantly as the racial diversity of the hospital population increased. We did, however, find that the odds of death for all patients increased as hospital diversity increased.”

To examine the association between the racial diversity of a hospital’s patient population and in-hospital mortality, Day and colleagues identified 161,560 nonsurgical patients receiving mechanical ventilation (MV) for pneumonia or sepsis from seven geographically and racially diverse Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases from 2018 to 2019. Of them, 13,786 identified as Black women and 58,828 identified as white men.

The researchers categorized hospitals into quartiles of racial diversity by percentage of patients with skin of color undergoing MV; hospitals with less than 25 patients with skin of color were excluded. They then evaluated the risk-adjusted odds of death for Black women compared with white men in all hospitals and by quartile of hospital diversity, as well as all patients based on quartile of hospital diversity.

The primary outcome was in-hospital mortality among patients who received MV for pneumonia or sepsis.

Overall, Black women had higher mortality than white men (37.6% vs. 36.9%; adjusted OR = 1.12; 95% CI, 1.07-1.18).

The researchers found that adjusted odds for death for Black women vs. white men did not vary between quartiles of hospital racial diversity (quartile 1: aOR = 1.07; 95% CI, 0.92-1.23; quartile 2: aOR = 1.14; 95% CI, 1.03-1.27; quartile 3: 1.12; 95% CI, 1.02-1.22; quartile 4: 1.11; 95% CI, 1.02-1.21).

However, when looking at all patients, researchers found that those admitted to hospitals with greater racial diversity had higher risk-adjusted hospital mortality, with adjusted odds ratios of 1.1 (95% CI, 1-1.2) for quartile 3 hospitals and 1.14 (95% CI, 1.04-1.24) for quartile 4 hospitals.

“The results from this study suggest that hospitals with more racial diversity experience strain that affects all patients,” Day said. “This strain could be the result of other factors such as staffing, hospital payer distribution or neighborhood income. These data highlight the importance of a careful examination of factors that could be contributing to these adverse outcomes and suggest a need for adjusting resource allocation both to reduce inequity and improve patient outcomes.”

In future studies, Day and colleagues will focus on understanding the large degree of intersectional variability in MV mortality.

“Our group plans to identify hospitals with high and low intersectional variability MV outcomes using quantitative, qualitative and survey methodology to better understand this variability,” Day said. “First, we plan to merge the HCUP [State Inpatient Databases] with the American Hospital Association Annual Survey that contains more than 200 hospital-level descriptors. We will evaluate if certain hospital characteristics such as ICU structure, academic status, staffing and payer composition are associated with high and low intersectional variability. In the future, we hope to conduct a mixed survey-qualitative study to evaluate patient and provider experiences of bias, discrimination and practice variability at high and low variability hospitals to further dissect the observed differences in outcomes.”

References:

• Day GL, et al. Am J Respir Crit Care Med. 2024;doi:10.1154/ajrccm-conference.2024.209.1_MeetingAbstracts.A2710.
• Hospitals caring for diverse patient populations have higher mechanical ventilation mortality. https://site.thoracic.org/about-us/news/2024-international-conference-press-release/hospitals-caring-for-diverse-patient-populations-have-higher-mechanical-ventilation-mortality. Published May 19, 2024. Accessed May 19, 2024.