Is there a sex or race difference in 30-day mortality after interruption of vena cava in a Medicare population?

PURPOSE

Disparities in health care and its outcome often indicate an opportunity for improving the quality of health care. Sex and rare differences in short-term mortality following interruption of vena cava are not known. The objective of this study was to determine such differences.

MATERIALS AND METHODS

With use of Medicare administrative data, 1,823 interruption of vena cava procedures performed between 1994 and 1997 were identified among beneficiaries aged 65-99 years residing in Indiana and Kentucky. In Cox proportional hazard regression models, male-to-female and nonwhite-to-white 30-day mortality ratios were adjusted for age, sex or race, weighted Charlson comorbidity score, length of hospital stay, and fatal coexisting conditions (ascertained from death certificate data).

RESULTS

Altogether, 277 patients died within 30 days after the procedure. Women were older than men. The comorbidity score was associated with male sex and mortality. There was no significant race difference in unadjusted or adjusted 30-day mortality after interruption of the vena cava. Unadjusted mortality was higher in men than in women (odds ratio, 1.49; 95% confidence interval [CI]=1.15, 1.92). Although adjustment for age, race, Charlson score, and length of hospital stay reduced the magnitude of sex difference, it remained significant. Further adjustment for fatal coexistent conditions reduced the sex difference to an insignificant level (odds ratio, 1.22; 95% CI=0.96, 1.56).

CONCLUSIONS

There was no significant sex or race difference in adjusted 30-day mortality after interruption of vena cava procedure in the elderly Medicare beneficiary population of two states.