Division of Pulmonary and Critical Care, Kaiser Permanente, Atlanta, GA, USA.
Crit Care Med. 2011 Mar;39(3):429-35. doi: 10.1097/CCM.0b013e318206b3af.
We sought to determine whether race or ethnicity is independently associated with mortality or intensive care unit length of stay among critically ill patients after accounting for patients' clinical and demographic characteristics including socioeconomic status and resuscitation preferences.
Historical cohort study of patients hospitalized in intensive care units.
Adult intensive care units in 35 California hospitals during the years 2001-2004.
A total of 9,518 intensive care unit patients (6,334 white, 655 black, 1,917 Hispanic, and 612 Asian/Pacific Islander patients).
The primary outcome was risk-adjusted mortality and a secondary outcome was risk-adjusted intensive care unit length of stay. Crude hospital mortality was 15.9% among the entire cohort. Asian patients had the highest crude hospital mortality at 18.6% and black patients had the lowest at 15.0%. After adjusting for age and gender, Hispanic and Asian patients had a higher risk of death compared to white patients, but these differences were not significant after additional adjustment for severity of illness. Black patients had more acute physiologic derangements at intensive care unit admission and longer unadjusted intensive care unit lengths of stay. Intensive care unit length of stay was not significantly different among racial/ethnic groups after adjustment for demographic, clinical, and socioeconomic factors and do-not-resuscitate status. In an analysis restricted only to those who died, decedent black patients averaged 1.1 additional days in the intensive care unit (95% confidence interval, 0.26-2.6) compared to white patients who died, although this was not statistically significant.
Hospital mortality and intensive care unit length of stay did not differ by race or ethnicity among this diverse cohort of critically ill patients after adjustment for severity of illness, resuscitation status, socioeconomic status, insurance status, and admission type. Black patients had more acute physiologic derangements at intensive care unit admission and were less likely to have a do-not-resuscitate order. These results suggest that among intensive care unit patients, there are no racial or ethnic differences in mortality within individual hospitals. If disparities in intensive care unit care exist, they may be explained by differences in the quality of care provided by hospitals that serve high proportions of minority patients.
在考虑患者的临床和人口统计学特征（包括社会经济地位和复苏偏好）后，我们旨在确定种族或民族是否与危重患者的死亡率或重症监护病房住院时间独立相关。
对 2001-2004 年间加利福尼亚州 35 家医院重症监护病房住院患者进行的历史队列研究。
成人重症监护病房。
共有 9518 例重症监护病房患者（6334 例白人、655 例黑人、1917 例西班牙裔和 612 例亚洲/太平洋岛民患者）。
主要结局是风险调整后的死亡率，次要结局是风险调整后的重症监护病房住院时间。整个队列的住院死亡率为 15.9%。亚洲患者的住院死亡率最高，为 18.6%，而黑人患者的死亡率最低，为 15.0%。在调整年龄和性别后，与白人患者相比，西班牙裔和亚洲患者的死亡风险更高，但在进一步调整疾病严重程度后，这些差异并不显著。黑人患者在重症监护病房入院时急性生理紊乱更严重，且未调整的重症监护病房住院时间更长。在调整人口统计学、临床和社会经济因素以及不复苏状态后，种族/民族群体之间的重症监护病房住院时间没有显著差异。在仅对死亡患者进行的分析中，与白人死亡患者相比，黑人死亡患者在重症监护病房的平均额外住院时间为 1.1 天（95%置信区间，0.26-2.6），尽管这在统计学上并不显著。
在调整疾病严重程度、复苏状态、社会经济地位、保险状况和入院类型后，在这个多样化的危重患者队列中，种族或民族与医院死亡率和重症监护病房住院时间无关。黑人患者在重症监护病房入院时急性生理紊乱更严重，且不太可能下达不复苏医嘱。这些结果表明，在重症监护病房患者中，各个医院之间的死亡率没有种族或民族差异。如果重症监护病房护理存在差异，这可能是由为高比例少数民族患者服务的医院提供的护理质量差异所解释。
