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Variation in the Incidence and Timing of Acute Lung InjuryRace and Incidence of Acute Lung Injury: The Role of Race

Colin R. Cooke, MD; Timothy R. Watkins, MD
Author and Funding Information

From the Division of Pulmonary and Critical Care Medicine (Dr Cooke); the Center for Healthcare Outcomes and Policy (Dr Cooke), University of Michigan; the Research Institute (Dr Watkins), Puget Sound Blood Center; and the Division of Pulmonary and Critical Care Medicine (Dr Watkins), University of Washington.

Correspondence to: Colin R. Cooke, MD, Center for Healthcare Outcomes and Policy, 2800 Plymouth Rd, Bldg 16, Room 127W, Ann Arbor, MI 48109; e-mail: cookecr@umich.edu


Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr Cooke is supported by a Mentored Clinical Scientist Research Career Development Award from the Agency for Healthcare Research and Quality [K08 HS020672]. Dr Watkins is supported by a Mentored Patient-Oriented Research Career Development Award from the National Institutes of Health, National Institute of General Medical Sciences [K23GM086729].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;143(4):881-882. doi:10.1378/chest.12-2683
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Over the past decade, the scientific community has gained a deeper understanding of the epidemiology of acute lung injury (ALI) and ARDS. Several high-quality studies have provided estimates of the incidence of ALI/ARDS, and have shown how incidence varies by age and what predicts mortality in this disease.1,2 Our understanding of how race/ethnicity influences an individual’s risk of developing ALI, however, is much less clear. Past population-based studies that characterized the incidence of ALI were conducted in geographic regions that did not reflect the typical racial/ethnic diversity of the United States, which prevented the presentation of race-specific estimates.1,2 At least one study of all-cause respiratory failure that included patients with ALI suggested that black patients experience a higher incidence of ALI.3 However, the International Classification of Diseases, Ninth Revision-based definition of respiratory failure used in this study left open the possibility that the observed racial differences in respiratory failure were due to causes other than true ALI. Most experts speculate that black patients are at an increased risk of developing ALI largely because black patients are at greater risk of sepsis and pneumonia,4,5 the two most common causes of ALI. In addition, several studies demonstrated that black patients die of ALI in greater numbers but appear to experience only slightly greater mortality once acquiring ALI, compared with white patients.6,7 Perhaps the most plausible explanation for the results of these studies is that the greater number of deaths due to ALI among black patients is most attributable to a higher incidence.

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