Differences in hospital mortality among critically ill patients of Asian, Native Indian, and European descent

Nadia A Khan, Anita Palepu, Monica Norena, Najib Ayas, Hubert Wong, Dean Chittock, Morad Hameed, Peter M Dodek
Chest 2008, 134 (6): 1217-1222

BACKGROUND: It is unclear whether race/ethnicity influences survival for acute critical illnesses. We compared hospital mortality among patients of Asian (originating from Asia or Southeast Asia), Native Indian, and European descent admitted to the ICU.

METHODS: Prospective cohort study of patients admitted to three ICUs (January 1999 to January 2006) in British Columbia, Canada. Multivariable analysis evaluated hospital mortality for each ethnic group, adjusting for age, sex, APACHE (acute physiology and chronic health evaluation) II score, hospital, median income, unemployment, and education. To account for differences in case mix, multivariable analysis was also restricted to those patients admitted for the five most common ICU admission diagnoses (sepsis, pneumonia, brain injury, COPD, and ARDS) and adjusted for these diagnoses.

RESULTS: Of 7,331 patients, 21% were Asian, 4% were Native Indian, and 75% were of European descent. Crude mortality was 33% for Asian, 30% for Native Indians, and 28% for patients of European descent. After adjusting for potential confounders, Native Indian descent was not associated with an increase in mortality compared to European descent. Asian descent was associated with a significantly higher mortality (odds ratio [OR], 1.22; 95% confidence interval [CI], 1.06 to 1.41; p = 0.005). After adjusting for case mix, this difference was no longer seen. For patients admitted for COPD exacerbation, Asian descent was associated with a substantial increase in mortality (OR, 4.5; 95% CI, 1.56 to 12.9; p = 0.005). There were no significant differences in mortality by race/ethnicity for patients who had any of the other common admitting diagnoses.

CONCLUSION: Patients of Asian and Native Indian descent with acute critical illness did not have an increased mortality after adjusting for differences in case mix.

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