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Original Research: CRITICAL CARE MEDICINE |

Differences in Hospital Mortality Among Critically Ill Patients of Asian, Native Indian, and European Descent

Nadia A. Khan, MD, MSc; Anita Palepu, MD, MPH; Monica Norena, MSc; Najib Ayas, MD, MPH; Hubert Wong, PhD; Dean Chittock, MD, MSc; Morad Hameed, MD, MPH; Peter M. Dodek, MD, MHSc
Author and Funding Information

*From the Centre for Health Evaluation and Outcome Sciences (Drs. Khan and Palepu, and Ms. Norena), Department of Medicine; Division of Pulmonary Medicine (Dr. Ayas); HIV Clinical Trials Network (Dr. Wong), Department of Medicine; Division of Critical Care Medicine (Drs. Chittock and Dodek); and Department of Surgery (Dr. Hameed), University of British Columbia, BC, Canada. Dr. Khan holds a St. Paul's Hospital Physician scholar award, a GENESIS Young investigator award, and a Canadian Institute for Health Research New Investigator award. Dr. Ayas is a Canadian Institute for Health Research New Investigator as well as a Michael Smith Foundation for Health Research scholar. Dr. Palepu is a Michael Smith Foundation for Health Research senior scholar.

Correspondence to: Nadia A. Khan, MD, MSc, 620-B 1081 Burrard St, Vancouver, BC, Canada, V6Z 1Y6; e-mail: nakhan@shaw.ca


This work was done at the Center for Health Evaluation and Outcomes Sciences, University of British Columbia, BC, Canada.

The authors have no conflicts of interest to disclose.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).


Chest. 2008;134(6):1217-1222. doi:10.1378/chest.08-1016
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Background:  It is unclear whether race/ethnicity influences survival for acute critical illnesses. We compared hospital mortality among patients of Asian (originating from Asia or Southeast Asia), Native Indian, and European descent admitted to the ICU.

Methods:  Prospective cohort study of patients admitted to three ICUs (January 1999 to January 2006) in British Columbia, Canada. Multivariable analysis evaluated hospital mortality for each ethnic group, adjusting for age, sex, APACHE (acute physiology and chronic health evaluation) II score, hospital, median income, unemployment, and education. To account for differences in case mix, multivariable analysis was also restricted to those patients admitted for the five most common ICU admission diagnoses (sepsis, pneumonia, brain injury, COPD, and ARDS) and adjusted for these diagnoses.

Results:  Of 7,331 patients, 21% were Asian, 4% were Native Indian, and 75% were of European descent. Crude mortality was 33% for Asian, 30% for Native Indians, and 28% for patients of European descent. After adjusting for potential confounders, Native Indian descent was not associated with an increase in mortality compared to European descent. Asian descent was associated with a significantly higher mortality (odds ratio [OR], 1.22; 95% confidence interval [CI], 1.06 to 1.41; p = 0.005). After adjusting for case mix, this difference was no longer seen. For patients admitted for COPD exacerbation, Asian descent was associated with a substantial increase in mortality (OR, 4.5; 95% CI, 1.56 to 12.9; p = 0.005). There were no significant differences in mortality by race/ethnicity for patients who had any of the other common admitting diagnoses.

Conclusion:  Patients of Asian and Native Indian descent with acute critical illness did not have an increased mortality after adjusting for differences in case mix.


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