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August 7, 1995

Racial Differences in Care Among Hospitalized Patients With Pneumocystis carinii Pneumonia in Chicago, New York, Los Angeles, Miami, and Raleigh-Durham

Author Affiliations

From the Departments of Medicine, Northwestern University, Chicago, Ill (Dr Bennett), Duke University, Durham, NC (Dr Homer), Cook County Hospital, Chicago (Dr Weinstein), University of Miami (Fla) (Dr Dickinson), State University of New York, Health Science Center, Brooklyn (Dr DeHovitz), Rochester (NY) University (Dr Cohn), Rush Medical College, Chicago (Drs Weinstein and Kessler), New York (NY) University (Dr Simberkoff), University of Illinois at Chicago (Dr Pitrak), and University of California— Los Angeles (Dr George); RAND, Santa Monica, Calif (Drs Bennett and Shapiro); the Western Region Special Studies Group of the Veterans Administration, Long Beach, Calif (Dr Gilman); and the Veterans Administration Medical Centers, Lakeside, Chicago (Dr Bennett), Durham (Dr Homer), Miami (Dr Dickinson), Bronx (NY) (Dr Jacobson), Sepulveda (Calif) (Dr Goetz), Westside, Chicago (Dr Pitrak), West Los Angeles (Dr George), and Long Beach (Dr Gilman).

Arch Intern Med. 1995;155(15):1586-1592. doi:10.1001/archinte.1995.00430150042005

Background:  While strategies for medical care for human immunodeficiency virus—related Pneumocystis carinii pneumonia (PCP) are well established, 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 tests 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 Administration (VA) patients and 1547 non-VA patients with empirically treated or cytologically confirmed PCP who were hospitalized from 1987 to 1990. Outcomes included representative aspects of the process of care for PCP and short-term mortality rates.

Results:  Among VA patients, black and Hispanic patients were not significantly different from white patients with regard to in-hospital mortality rates, use and timing of a bronchoscopy, or receipt of timely anti-PCP medications. Among non-VA 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 differences in the use of a bronchoscopy and in-hospital mortality among non-VA patients were almost fully accounted for by differences in health insurance status and hospital characteristics.

Conclusions:  Racial factors do not appear to be an important determinant of the intensity of diagnostic or therapeutic care among patients who are hospitalized with PCP. Variations in care are largely attributable to differences in health insurance and admitting hospital characteristics.(Arch Intern Med. 1995;155:1586-1592)