Surviving Confusion- Differences in Survival among Older African Americans and Whites Hospitalized with Delirium Diagnoses in the United States
Clinical Medicine Research
Volume 3, Issue 3, May 2014, Pages: 68-73
Received: Apr. 22, 2014;
Accepted: May 22, 2014;
Published: Jun. 10, 2014
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Stephanie Lynn Garrett, Dept. of Family Medicine & National Center for Primary Care (NCPC), Morehouse School of Medicine, Atlanta GA, USA
Peter T. Baltrus, Community Health & Preventive Medicine & NCPC, Morehouse School of Medicine, Atlanta GA, USA
Patrick A. Griffith, Dept. of Medicine, Chief of Neurology, Morehouse School of Medicine, Atlanta GA, USA
George Staben Rust, National Center for Primary Care & Dept. of Family Medicine, Morehouse School of Medicine, Atlanta GA, USA
Background: Little is known regarding in-hospital mortality for older African Americans hospitalized with delirium diagnoses. Objectives: To estimate the in-hospital mortality for older African Americans hospitalized with delirium diagnoses based on a national representative sample; differences in this outcome and other determinants of morbidity (i.e. length of stay) between well studied populations (non-Hispanic Whites) and African Americans was also the focus. Design: Retrospective cohort study. Setting: Database of hospital discharges from the 2006 Nationwide Inpatient Sample (NIS), a subset of the Healthcare Cost and Utilization Project (HCUP) from the Agency for Healthcare Research and Quality (AHRQ). Participants: Represented 54,003 hospital discharges for those 65 years old and above, both African Americans and non-Hispanic Whites discharged from US hospitals. Key Outcomes: In-hospital mortality and length of stay. Results: Among delirious patients, African Americans had a longer mean length of stay (LOS) than non-Hispanic Whites (7.8 vs. 7.3 days, p=0.005). A larger percentage of non-Hispanic White patients (7.4%) compared to African American patients (6.6%) died during their stay in the hospital, however this was not statistically significant (p=0.076). Limitations: Suspected under-detection of delirium by providers and the subsequent diminished diagnostic capture by evidence of paid billing claims. Conclusion: The in-hospital mortality rate for non-Hispanic White patients hospitalized with diagnoses of delirium was also significantly less than that found in other studies (7.3 vs. 9%) indicating that detection of delirium and its subsequent diagnostic capture in these claims data may have been very low. The most likely explanation is that determining mortality estimates for an already under-diagnosed syndrome based on claims diagnostic data may be suboptimal. Alternatively, these results may indicate that delirium is profoundly under-diagnosed in elderly hospitalized African Americans as compared to their non-Hispanic White counterparts.
Stephanie Lynn Garrett,
Peter T. Baltrus,
Patrick A. Griffith,
George Staben Rust,
Surviving Confusion- Differences in Survival among Older African Americans and Whites Hospitalized with Delirium Diagnoses in the United States, Clinical Medicine Research.
Vol. 3, No. 3,
2014, pp. 68-73.
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