Racial and ethnic disparities in mortality from acute lung injury*

Abstract

Objective: Little is known about the influence of race and ethnicity on mortality from acute lung injury. We sought to determine whether black race or Hispanic ethnicity are independently associated with mortality among patients with acute lung injury. Design:Retrospective cohort study of patients enrolled in the Acute Respiratory Distress Syndrome (ARDS) Network randomized controlled trials.Setting: Adult intensive care units participating in the ARDS Network trials.Patients: 2362 mechanically ventilated patients (1,715 white, 449 black and 198 Hispanic) with acute lung injury. Measurements and Main Results:The primary outcome was 60-day mortality. A secondary outcome was number of ventilator-free days. Crude mortality was 33% for both blacks and Hispanics compared with 27% for whites (p=0.02). After adjusting for demographic and clinical covariates, the association between race/ethnicity and mortality persisted (OR = 1.42; 95% CI 1.10-1.84 for blacks; OR=1.94; 95% CI, 1.36-2.77 for Hispanics; OR=1 for whites, reference). After adjustment for severity of illness (Acute Physiology Score), black race was no longer significantly associated with mortality (OR =1.25; 95% CI, 0.95-1.66), whereas the association with Hispanic ethnicity persisted (OR=2.00; 95% CI, 1.37-2.90). Hispanics had significantly fewer ventilator-free days compared with whites after adjustment for demographic and clinical covariates (mean difference in days = -2.3; 95% CI -3.9 to -0.7). Conclusions:Black and Hispanic patients with acute lung injury have a significantly higher risk of death compared to white patients. This increased risk appeared to be mediated by increased severity of illness at presentation for blacks, but was unexplained among Hispanics.

Effect of Heme Oxygenase-1 on Mitofusin-1 protein in LPS-induced ALI/ARDS in rats

“…To our knowledge, the most common indirect pulmonary injury leading to ALI/ARDS is caused by LPS from the outer cell wall of Gram-negative bacteria19. Therefore, our in vivo study used international studies and our previous studies to select the intravenous LPS 5 mg/kg method to model ALI/ARDS in rats20.…”

Economic disparities and survival from critical illness

“…Within US clinical trials, ARDS survival is lower among black and Hispanic patients than white patients, and this disparity is incompletely explained by illness severity. 8 The effect of social factors on ARDS outcomes will need to be rigorously distinguished from other potential explanations for geographical variation, including differences in cause (infectious or otherwise) or variations in host genetic susceptibility. Laffey and colleagues’ study emphasises the crucial need to untangle the complex social, economic, demographic, genetic, and causative forces that interact to shape a given patient’s disease course.…”

Evolving Epidemiology and Definitions of the Acute Respiratory Distress Syndrome and Early Acute Lung Injury

“…67 Among patients enrolled in more recent ARDS Network clinical trials, mortality was greater among blacks and Hispanics. 68 After adjustment for demographics, clinical covariates, and severity of illness, mortality among blacks was not significantly higher than in whites (adjusted OR 1.25, 95% CI 0.95-1.66) while the relative mortality among Hispanics actually increased (adjusted OR 2.0, 95% CI 1.37-2.90). The reason for increased mortality among Hispanics is not known, although it deserves further attention given that this finding occurred in patients enrolled in clinical trials where care is presumably more standardized.…”