Abstract: Demographic and Clinical Factors Associated with In-Hospital Death Among Patients with Systemic Sclerosis

Demographic and Clinical Factors Associated with In-Hospital Death Among Patients with Systemic Sclerosis

PAUL J. NIETERT, RICHARD M. SILVER, HOLLY C. MITCHELL, STEPHANIE R. SHAFTMAN, and BARBARA C. TILLEY

ABSTRACT.

Objective. To examine demographic and clinical predictors of in-hospital death of patients with systemic sclerosis (SSc) and determine to what extent apparent racial differences may be attributed to socioeconomic factors.

Methods. Data were obtained on all hospitalizations in South Carolina for patients who were ever hospitalized between 1996 and 2000 with a diagnosis of SSc. Multiple logistic regression was used to examine predictors of in-hospital death among whites, blacks, and other patients.

Results. Proportions of in-hospital deaths among blacks (23.0%) and others (27.7%) were higher than among whites (15.6%), a finding that remained after adjustment for other sociodemographic and clinical factors (black/white odds ratio: 1.70, 95% confidence interval: 1.01–2.86; other/white OR 2.06, 95% CI 1.04–4.09). Other factors associated with in-hospital death included transfer status, emergency admission, length of stay, number of hospitalizations during the time period, and presence of congestive heart failure (OR 1.79; 95% CI 1.06–3.03) or hypertension (OR 0.41; 95% CI 0.23–0.71).

Conclusion. Black and other non-white patients with SSc appear to experience an elevated risk of death during their hospital stays. Further research is necessary to understand the reasons for these disparities. (J Rheumatol 2005;32:1888-92)

Key Indexing Terms:

SYSTEMIC SCLEROSIS
HOSPITAL MORTALITY
CONTINENTAL POPULATION GROUPS
RACIAL DISPARITIES

From the Department of Biostatistics, Bioinformatics, and Epidemiology, and the Department of Medicine and Division of Rheumatology, Medical University of South Carolina, Charleston, South Carolina, USA.

Supported in part by the "Multidisciplinary Clinical Research Center for Rheumatic Diseases in African-Americans" grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health (grant No. 1 P60 AR049459).

P.J. Nietert, PhD, Department of Biostatistics, Bioinformatics, and Epidemiology; R.M. Silver, MD; H.C. Mitchell, MD, Department of Medicine and Division of Rheumatology; S.R. Shaftman, MSc, MS; B.C. Tilley, PhD, Department of Biostatistics, Bioinformatics, and Epidemiology.

Address reprint requests to Dr. P.J. Nietert, Center for Health Care Research, 135 Cannon Street, Suite 403, PO Box 250837, Charleston, SC 29425, USA. E-mail: nieterpj@musc.edu

Accepted for publication May 9, 2005.