Short- and Long-Term Mortality after an Acute Illness for Elderly Whites and Blacks

Authors

  • Daniel Polsky,

    1. VA Center for Health Equity Research and Promotion; Department of General Internal Medicine, University of Pennsylvania School of Medicine and the Department of Health Care Systems, the Wharton School, University of Pennsylvania, Blockley Hall, Rm. 1212, 423 Guardian Drive, Philadelphia, PA 19104, 215-573-5752,
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    • Address correspondence to Daniel Polsky, Ph.D., VA Center for Health Equity Research and Promotion; Department of General Internal Medicine, University of Pennsylvania School of Medicine and the Department of Health Care Systems, the Wharton School, University of Pennsylvania, Blockley Hall, Rm. 1212, 423 Guardian Drive, Philadelphia, PA 19104, 215-573-5752. E-mail: polsky@mail.med.upenn.edu. Ashish Jha, M.D., M.P.H., is with the VA Boston Health Care System and the Department of Health and Policy Management, Harvard School of Public Health, Boston, MA. Judith Lave, Ph.D., is with the Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA. Mark Pauly, Ph.D., is with the Health Care Systems Department, the Wharton School, University of Pennsylvania, Philadelphia, PA. Liyi Cen, M.S., is with the Division of General Internal Medicine, University of Pennsylvania, Philadelphia PA. Heather Klusaritz, M.S.W., is with the VA Center for Health Equity Research and Promotion and the School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA. Zhen Chen, Ph.D., is with the Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, PA. Kevin Volpp, M.D., Ph.D., is with the VA Center for Health Equity Research and Promotion and the Department of General Internal Medicine, University of Pennsylvania School of Medicine, and the Department of Health Care Systems, the Wharton School, University of Pennsylvania, Philadelphia, PA.

  • Ashish K. Jha,

    1. VA Boston Health Care System and the Department of Health and Policy Management, Harvard School of Public Health, Boston, MA,
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  • Judith Lave,

    1. Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA,
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  • Mark V. Pauly,

    1. Health Care Systems Department, the Wharton School, University of Pennsylvania, Philadelphia, PA,
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  • Liyi Cen,

    1. Division of General Internal Medicine, University of Pennsylvania, Philadelphia PA,
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  • Heather Klusaritz,

    1. VA Center for Health Equity Research and Promotion and the School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA,
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  • Zhen Chen,

    1. Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, PA, and
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  • Kevin G. Volpp

    1. VA Center for Health Equity Research and Promotion and the Department of General Internal Medicine, University of Pennsylvania School of Medicine, and the Department of Health Care Systems, the Wharton School, University of Pennsylvania, Philadelphia, PA
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Abstract

Objective. To estimate racial differences in mortality at 30 days and up to 2 years following a hospital admission for the elderly with common medical conditions.

Data Sources. The Medicare Provider Analysis and Review File and the VA Patient Treatment File from 1998 to 2002 were used to extract patients 65 or older admitted with a principal diagnosis of acute myocardial infarction, stroke, hip fracture, gastrointestinal bleeding, congestive heart failure, or pneumonia.

Study Design. A retrospective analysis of risk-adjusted mortality after hospital admission for blacks and whites by medical condition and in different hospital settings.

Principal Findings. Black Medicare patients had consistently lower adjusted 30-day mortality than white Medicare patients, but the initial survival advantage observed among blacks dissipated beyond 30 days and reversed by 2 years. For VA hospitalizations similar patterns were observed, but the initial survival advantage for blacks dissipated at a slower rate.

Conclusions. Racial disparities in health are more likely to be generated in the posthospital phase of the process of care delivery rather than during the hospital stay. The slower rate of increase in relative mortality among black VA patients suggests an integrated health care delivery system like the VA may attenuate racial disparities in health.

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