AFRICAN-AMERICAN AND WHITE PATIENTS ADMITTED TO THE INTENSIVE-CARE UNIT - IS THERE A DIFFERENCE IN THERAPY AND OUTCOME

Objective: To evaluate variations in patient characteristics, hospital mortality, intensive care unit (ICU) length of stay, and treatment am ong African-American and white patients admitted to the ICU. Design: P rospective, inception cohort study, Setting: 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 ce nters, Patients: A consecutive sample of 17,440 ICU admissions, Measur ements and Main Results: Selected demographic, physiologic, and treatm ent information for an average of 415 admissions at each ICU, and payo r 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 se ven ICU days, Compared with 14,006 white patients admitted to the ICU, 2,450 African-American patient admissions were significantly (p < .00 01) younger, had a higher mean severity of disease, and a greater prop ortion of nonoperative and emergency department admissions, African-Am ericans had fewer life-threatening Acute Physiology and Chronic Health Evaluation III (APACHE III) comorbidities, but a higher prevalence of severe compromise in activities of dally living, diabetes mellitus, c hronic renal disease, and intravenous drug abuse, There was no signifi cant racial difference in risk-adjusted hospital mortality rate, For A frican-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%), Conclusi ons: After adjusting for variations in patient characteristics at ICU admission, race has no significant effect on hospital survival, The sm all but statistically significant differences in adjusted ICU length o f stay and resource use could indicate undertreatment for African-Amer icans or overtreatment for whites.