Open AccessRacial/Ethnic Disparities in Mortality Among Medicare Beneficiaries in the FL ‐ PR CR eSD Study
Author(s) -
Gardener Hannah,
Leifheit Erica C.,
Lichtman Judith H.,
Wang Yun,
Wang Kefeng,
Gutierrez Carolina M.,
CilibertiVargas Maria A.,
Dong Chuanhui,
Oluwole Sofia,
Robichaux Mary,
Romano Jose G.,
Rundek Tatjana,
Sacco Ralph L.
Publication year - 2019
Publication title -
journal of the american heart association
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.494
H-Index - 85
ISSN - 2047-9980
DOI - 10.1161/jaha.118.009649
Subject(s) - medicine , hazard ratio , odds ratio , confidence interval , ethnic group , demography , stroke (engine) , logistic regression , population , gerontology , environmental health , mechanical engineering , sociology , anthropology , engineering
Background Racial/ethnic disparities in acute stroke care may impact stroke outcomes. We compared outcomes by race/ethnicity among elderly Medicare beneficiaries in hospitals participating in the FL‐PR CReSD (Florida–Puerto Rico Collaboration to Reduce Stroke Disparities) registry with those in hospitals not participating in any quality improvement programs (non‐ QI ) in Florida and Puerto Rico (PR). Methods and Results The population included fee‐for‐service Medicare beneficiaries age 65+ in Florida and PR , discharged with primary diagnosis of ischemic stroke ( International Classification of Diseases, Ninth Revision, Clinical Modification [ICD‐9‐CM], codes 433, 434, 436) in 2010–2013. We used mixed logistic models to assess racial/ethnic differences in outcomes (in‐hospital, 30‐day, and 1‐year mortality, and 30‐day readmission) for CR e SD and non‐ QI hospitals, adjusted for demographic and clinical characteristics. The study included 62 CR e SD hospitals (N=44 013, 84% white, 9% black, 4% Florida Hispanic, 1% PR Hispanic) and 113 non‐ QI hospitals (N=14 422, 78% white, 7% black, 5% Florida Hispanic, 8% PR Hispanic). For patients treated at CR e SD hospitals, there were no differences in risk‐adjusted in‐hospital mortality by race/ethnicity; blacks had lower 30‐day mortality versus whites (odds ratio, 0.86; 95% confidence interval, 0.77–0.97), but higher 30‐day readmission (hazard ratio, 1.09; 1.00–1.18) and 1‐year mortality (odds ratio, 1.13; 1.04–1.23); Florida Hispanics had lower 30‐day readmission (hazard ratio, 0.87; 0.78–0.98). PR Hispanic and black stroke patients treated at non‐ QI hospitals had higher risk‐adjusted in‐hospital, 30‐day and 1‐year mortality, but similar 30‐day readmission versus whites treated in non‐ QI hospitals. Conclusions Disparities in outcomes were less common in CR e SD than non‐ QI hospitals, suggesting the benefits of quality improvement programs, particularly those focusing on racial/ethnic disparities.