Racial differences in hospital mortality for medical and surgical admissions: variations by patient and hospital characteristics.

OBJECTIVE To determine if there are disparities between White and Black inpatient mortality rates for specific medical and surgical conditions and whether disparities vary by patient and hospital subgroups. DESIGN, SETTING, PARTICIPANTS All-payer discharge records in the 2009 Healthcare Cost and Utilization Project, State Inpatient Databases (SID) for 36 states that comprised about 80% of the Black and White populations in the United States were used to create a random, stratified sample of about 1,900 community hospitals (a 40% sample of US hospitals). All discharges in the hospitals were included and weighted for national estimates. MAIN OUTCOME MEASURES Inpatient Quality Indicators, developed by the Agency for Healthcare Research and Quality, were used to measure risk-adjusted hospital mortality for six medical conditions and four surgeries. National estimates compared non-Hispanic Whites to Blacks by patient and hospital characteristics. RESULTS Blacks had lower mortality for all medical conditions compared to Whites. However, they had higher mortality rates for two surgical procedures (coronary artery bypass graft and craniotomy) and lower mortality for one surgery (abdominal aortic anuerysm repair). These patterns held for most, though not all, patient and hospital subgroups for medical conditions, but disparities typically varied by subgroup for surgeries. CONCLUSIONS Policymakers and researchers may use these findings in targeting interventions, designing quality reporting programs and designing studies on why the disparities exist and how to reduce them.