RACIAL-DIFFERENCES IN CARE AMONG HOSPITALIZED-PATIENTS WITH PNEUMOCYSTIS-CARINII PNEUMONIA IN CHICAGO, NEW-YORK, LOS-ANGELES, MIAMI, AND RALEIGH-DURHAM

Background: While strategies for medical care for human immunodeficien cy virus-related Pneumocystis carinii pneumonia (PCP) are well establi shed, racial variations in care have not been evaluated. Objective: To determine whether sociodemographic characteristics influence patterns of care and patient outcomes, by analyzing the use of diagnostic test s and anti-PCP medications and in-hospital mortality rates for persons who were hospitalized with human immunodeficiency virus-related PCP. Methods: Retrospective chart review of a cohort of 627 Veterans Admini stration (VA) patients and 1547 non-VA patients with empirically treat ed or cytologically confirmed PCP who were hospitalized from 1987 to 1 990. Outcomes included representative aspects of the process of care f or PCP and short-term mortality rates. Results: Among VA patients, bla ck and Hispanic patients were not significantly different from white p atients with regard to in-hospital mortality rates, use and timing of a bronchoscopy, or receipt of timely anti-PCP medications. Among non-V A patients, black and Hispanic patients were more likely to die in the hospital and less likely to undergo a diagnostic bronchoscopy in the first 2 days of hospitalization. These racial and ethnic group differe nces in the use of a bronchoscopy and in-hospital mortality among non- VA patients were almost fully accounted for by differences in health i nsurance status and hospital characteristics. Conclusions: Racial fact ors do not appear to be an important determinant of the intensity of d iagnostic or therapeutic care among patients who are hospitalized with PCP. Variations in care are largely attributable to differences in he alth insurance and admitting hospital characteristics.