Health Services Research & Development

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2006 HSR&D National Meeting Abstract


1060 — Racial Disparities: A Comparison of Outcomes from Inpatient Admission in VA and Non-VA Hospitals

Author List:
Polsky DP (CHERP)
Lave J (CHERP)
Jha AK (Boston VA)
Pauly MV (CHERP)
Chen Z (CHERP)
Cen L (CHERP)
Klusaritz H (CHERP)
Volpp KG (CHERP)

Objectives:
30-day mortality following hospital admission within VA is lower for black patients relative to white patients; a finding that contrasts sharply with the lower treatment levels and life expectancy for U.S. blacks. This differential finding may be a result of VA’s integrated health care system which reduces barriers to care through subsidized comprehensive health care services. Our objective was to examine the role of systems of care in racial health disparities by comparing 30-day mortality following hospital admissions to VA and non-VA hospitals.

Methods:
We examined 30-day mortality rates for blacks and whites following hospital admissions for six medical conditions between 1996 and 2001 in all acute care VA hospitals, and in acute care non-VA hospitals in Pennsylvania and California. We chose conditions that are part of the AHRQ Inpatient Quality Indicators: acute myocardial infarction (AMI), congestive heart failure (CHF), gastrointestinal bleeding, hip fracture, pneumonia, and stroke. We used logistic regression to adjust for differences in demographic factors, comorbidities, and race within VA and non-VA hospitals. Further, we assessed interactions involving race, hospital system, and age.

Results:
There were 346,301 VA patients and 2,935,543 non-VA patients in our dataset. Among those under 65, blacks and whites had similar 30-day mortality for 5 of 6 conditions in both VA and non-VA hospitals. For example, odds ratios for AMI: VA:1.13 [95%CI: 0.94-1.37] and non-VA:0.95 [0.86-1.04]. Among those over age 65, blacks were less likely to die than whites in both VA and non-VA hospitals (Odds ratio AMI: VA:0.81 [0.72-0.91]; non-VA:0.84 [0.79-0.88]). The gap in mortality between blacks and whites was comparable between VA and non-VA hospitals in 4 of the 6 conditions. In the other two conditions, CHF and pneumonia, this gap in mortality favored blacks more in non-VA hospitals compared to VA hospitals.

Implications:
These findings suggest that factors associated with better short-term outcomes for blacks are not unique to VA.

Impacts:
These results suggest that interventions aimed at reducing health disparities and improving the well-being and life expectancy of blacks may need to focus on settings besides hospital care.