Williams J F, Zimmerman J E, Wagner D P, Hawkins M, Knaus W A
Department of Anesthesiology, George Washington University Medical Center, Washington, DC 20037, USA.
Crit Care Med. 1995 Apr;23(4):626-36. doi: 10.1097/00003246-199504000-00009.
To evaluate variations in patient characteristics, hospital mortality, intensive care unit (ICU) length of stay, and treatment among African-American and white patients admitted to the ICU.
Prospective, inception cohort study.
Forty-two ICUs at 40 U.S. hospitals, including 26 hospitals that were randomly selected and 14 volunteer institutions, primarily large university or tertiary care centers.
A consecutive sample of 17,440 ICU admissions.
Selected demographic, physiologic, and treatment information for an average of 415 admissions at each ICU, and payor information at 36 of 40 hospitals. Outcomes were compared using the ratio of observed to risk-adjusted predicted hospital mortality rate, ICU length of stay, and resource use during ICU day 1 and the first seven ICU days. Compared with 14,006 white patients admitted to the ICU, 2,450 African-American patient admissions were significantly (p < .0001) younger, had a higher mean severity of disease, and a greater proportion of nonoperative and emergency department admissions. African-Americans had fewer life-threatening Acute Physiology and Chronic Health Evaluation III (APACHE III) comorbidities, but a higher prevalence of severe compromise in activities of daily living, diabetes mellitus, chronic renal disease, and intravenous drug abuse. There was no significant racial difference in risk-adjusted hospital mortality rate. For African-Americans, adjusted ICU length of stay was significantly (p < .0003) shorter, and the first 7 days of resource use was significantly (p < .0004) lower, but the differences were small (3% to 4%).
After adjusting for variations in patient characteristics at ICU admission, race has no significant effect on hospital survival. The small but statistically significant differences in adjusted ICU length of stay and resource use could indicate undertreatment for African-Americans or overtreatment for whites.
评估入住重症监护病房（ICU）的非裔美国患者和白人患者在患者特征、医院死亡率、ICU住院时间及治疗方面的差异。
前瞻性队列研究。
美国40家医院的42个ICU，其中包括26家随机选取的医院和14家志愿机构，主要是大型大学或三级医疗中心。
连续抽取的17440例ICU入院患者样本。
收集每个ICU平均415例入院患者的选定人口统计学、生理学和治疗信息，以及40家医院中36家的付款人信息。使用观察到的与风险调整预测的医院死亡率、ICU住院时间以及ICU第1天和前7天的资源使用比例来比较结果。与14006例入住ICU的白人患者相比，2450例非裔美国患者入院时明显更年轻（p <.0001），疾病平均严重程度更高，非手术和急诊科入院比例更大。非裔美国人危及生命的急性生理与慢性健康状况评估Ⅲ（APACHEⅢ）合并症较少，但日常生活活动严重受限、糖尿病、慢性肾病和静脉药物滥用的患病率较高。风险调整后的医院死亡率无显著种族差异。对于非裔美国人，调整后的ICU住院时间明显更短（p <.0003），前7天的资源使用明显更低（p <.0004），但差异较小（3%至4%）。
在调整ICU入院时患者特征的差异后，种族对医院生存率无显著影响。调整后的ICU住院时间和资源使用存在虽小但具有统计学意义的差异，这可能表明非裔美国人治疗不足或白人治疗过度。
