Surviving Confusion- Differences in Survival among Older African Americans and Whites Hospitalized with Delirium Diagnoses in the United States

Stephanie Lynn Garrett; Peter T. Baltrus; Patrick A. Griffith; George Staben Rust

doi:doi:10.11648/j.cmr.20140303.14

| Peer-Reviewed

Surviving Confusion- Differences in Survival among Older African Americans and Whites Hospitalized with Delirium Diagnoses in the United States

Stephanie Lynn Garrett, Peter T. Baltrus, Patrick A. Griffith, George Staben Rust

Published in Clinical Medicine Research (Volume 3, Issue 3)

Received: 22 April 2014 Accepted: 22 May 2014 Published: 10 June 2014

Views: Downloads:

Download PDF

Share This Article

Twitter
Linked In
Facebook

Abstract

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.

Published in	Clinical Medicine Research (Volume 3, Issue 3)
DOI	10.11648/j.cmr.20140303.14
Page(s)	68-73
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2014. Published by Science Publishing Group

Keywords

Vulnerable Populations, Delirium, Disparities

References

[1]	T. G. Fong, S. R. Tulebaev, S. K. Inouye Delirium in elderly adults: diagnosis, prevention and treat-ment Nature Reviews. Neurology 2009 vol. 5, pp. 210-220.
[2]	HCUP Healthcare Cost and Utilization Project Statistical Brief #6. Hospitalizations in the elderly Population, 2003. AHRQ Agency for Healthcare Research and Quality:1-8 (online). Available at: www.hcup-us.ahrq.gov/reports/statbriefs/sb6.pdf. Accessed April12, 2011.
[3]	S. K. Inouye, J. T. Rushing, M.D. Foreman, R. M. Palmer, P. Pompei Does delirium contribute to poor hospital out-comes? A three site epidemiologic study Journal of General Internal Medicine 1998 vol.13, pp. 234-242.
[4]	E. R. Marcantonio, D. K. Kiely, S.E. Simon, O. E. John, R. N. Jones et al., Out-comes of older people admitted to postacute facilities with delirium, Journal of the American Ge-riatrics Society 2005 vol. 53, no. 6, pp. 963-969.
[5]	D. L. Leslie, E. R. Marcantonio, Y. Zhang, L. Leo-Summers, S. K. Inouye One-year healthcare costs associated with delirium in the elderly population Archives of internal medicine 2008 vol. 168, no.1, pp. 27-32.
[6]	S. K. Inouye, C. H. Van Dyck, C. A. Alessi, S. Balkin, A. P. Siegal et al Clarifying confusion: the confusion assessment method. A new method for detection of delirium in hospitalized older patients The New England journal of medicine 1990 vol. 113, no.12, pp. 941-948.
[7]	S. K. Inouye, S. T. Bogardus, P. A. Charpentier, L. Leo-Summers, D. Acampora et al A Multicomponent intervention to prevent deli-rium in hospitalized older patients The New England journal of medicine 1999, vol. 340, no. 9, pp. 669-676.
[8]	Nationwide Inpatient Sample (NIS) 2006, Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality. Available at: HCUPDistributor@ahrq.gov. Pur-chased November 1, 2010.
[9]	Healthcare Cost and Utilization Project (HCUP). DATA USE AGREEMENT for the Nationwide Inpatient Sample from the Healthcare Cost and Utilization Project Agency for Healthcare Research and Quality. (Version)Revised 6-25-08:1-4 (online). Avail-able at: www.ahrq.gov/data/hcup/. Accessed February 21, 2011.
[10]	J. R. Pippins, G. M. Fitzmau-rice, J. S. Haas Hospital characteristics and racial disparities in hospital mortality from common medical conditions Journal of the National Medical Association 2007 vol. 99, no.9, pp. 1030-1036.
[11]	K. S. Cahill, J. H. Chi, A. Day, E. B. Claus Prevalence, complications, and hos-pital charges associated with use of bone-morphogenetic proteins in spinal fusion procedures JAMA: the journal of the American Medical Association 2009 vol. 302, no. 1, pp. 58-66.
[12]	J. A. Cowan, J. B. Dimick, R. M. Wainess et al Outcomes after cerebral aneurysm clip occlusion in the United States: the need for evidence-based hospital referral Journal of neurosurgery 2003 vol. 96, no.6, pp. 947-952.
[13]	R. M. Worth, R. E. Mytinger Medical insurance claims as a source of data for research: accuracy of diagnostic coding Hawaii medical journal January 1996 vol. 55, no. 1, pp. 9-11. PubMed PMID: 8786232
[14]	S. Schneeweiss, J. Avorn A review of uses of healthcare utilization databases for epidemiologic research on therapeutics Journal of clinical epidemiology 2005 vol. 58, pp. 323-337.
[15]	A. Edlund, M. Lundström, S. Karlsson, B. Brännström G. Bucht et al Delirium in older patients admitted to general internal medicine Jour-nal of geriatric psychiatry and neurology 2006 vol. 19, no. 2, pp. 83-90.
[16]	D. Adamis, A. Treloar, F. Z. Darwiche, N. Gregson, A. J. Macdonald et al. Associations of delirium with in-hospital and 6-months mortality in elderly medical inpatients Age and ageing 2007 vol. 36, pp. 644-649. PubMed PMID: 17660528
[17]	L. R. Hausmann, S. A. Ibrahim, A. Mehrotra, W. Nsa, D. W. Bratzler et al Racial and Ethnic Disparities in Pneumonia Treatment and Mortality Medical care 2009 vol. 47, no. 9, pp. 1009-1018.
[18]	S. K. Inouye, L. Leo-Summers, Y. Zhang, S. T. Bogardus Jr, D. L. Leslie et al A chart-based method for identification of delirium: Validation compared with interviewer ratings using the Confusion Assessment Method Journal of the American Geriatrics Society 2005 vol. 53, pp. 312-318.
[19]	C. H. Wilkins, K. L. Wilkins, M. Meisel, M. Depke, J. Wil-liams et al Dementia undiagnosed in poor older adults with functional impairment Journal of the American Geriatrics Society 2007 vol. 55, pp. 1771-1776. PubMed PMID: 12351915
[20]	H. C. Kales, B. A. Kamholz, S. G. Visnic, F. C. Blow Recorded delirium in a national sample of inpatients: potential implications for recognition Journal of geriatric psychiatry and neurology 2003 vol. 16, no.1, pp. 32-8. PMID: 12641371

Cite This Article

Plain Text BibTeX RIS

APA Style

Stephanie Lynn Garrett, Peter T. Baltrus, Patrick A. Griffith, George Staben Rust. (2014). Surviving Confusion- Differences in Survival among Older African Americans and Whites Hospitalized with Delirium Diagnoses in the United States. Clinical Medicine Research, 3(3), 68-73. https://doi.org/10.11648/j.cmr.20140303.14

Copy | Download

ACS Style

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. Clin. Med. Res. 2014, 3(3), 68-73. doi: 10.11648/j.cmr.20140303.14

Copy | Download

AMA Style

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. Clin Med Res. 2014;3(3):68-73. doi: 10.11648/j.cmr.20140303.14

Copy | Download

@article{10.11648/j.cmr.20140303.14,
  author = {Stephanie Lynn Garrett and Peter T. Baltrus and Patrick A. Griffith and George Staben Rust},
  title = {Surviving Confusion- Differences in Survival among Older African Americans and Whites Hospitalized with Delirium Diagnoses in the United States},
  journal = {Clinical Medicine Research},
  volume = {3},
  number = {3},
  pages = {68-73},
  doi = {10.11648/j.cmr.20140303.14},
  url = {https://doi.org/10.11648/j.cmr.20140303.14},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.cmr.20140303.14},
  abstract = {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.},
 year = {2014}
}

Copy | Download

TY - JOUR
T1 - Surviving Confusion- Differences in Survival among Older African Americans and Whites Hospitalized with Delirium Diagnoses in the United States
AU - Stephanie Lynn Garrett
AU - Peter T. Baltrus
AU - Patrick A. Griffith
AU - George Staben Rust
Y1 - 2014/06/10
PY - 2014
N1 - https://doi.org/10.11648/j.cmr.20140303.14
DO - 10.11648/j.cmr.20140303.14
T2 - Clinical Medicine Research
JF - Clinical Medicine Research
JO - Clinical Medicine Research
SP - 68
EP - 73
PB - Science Publishing Group
SN - 2326-9057
UR - https://doi.org/10.11648/j.cmr.20140303.14
AB - 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.
VL - 3
IS - 3
ER -

Copy | Download

Author Information

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

Download PDF

Sections

Plain Text BibTeX RIS

APA Style

Stephanie Lynn Garrett, Peter T. Baltrus, Patrick A. Griffith, George Staben Rust. (2014). Surviving Confusion- Differences in Survival among Older African Americans and Whites Hospitalized with Delirium Diagnoses in the United States. Clinical Medicine Research, 3(3), 68-73. https://doi.org/10.11648/j.cmr.20140303.14

Copy | Download

ACS Style

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. Clin. Med. Res. 2014, 3(3), 68-73. doi: 10.11648/j.cmr.20140303.14

Copy | Download

AMA Style

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. Clin Med Res. 2014;3(3):68-73. doi: 10.11648/j.cmr.20140303.14

Copy | Download

@article{10.11648/j.cmr.20140303.14,
  author = {Stephanie Lynn Garrett and Peter T. Baltrus and Patrick A. Griffith and George Staben Rust},
  title = {Surviving Confusion- Differences in Survival among Older African Americans and Whites Hospitalized with Delirium Diagnoses in the United States},
  journal = {Clinical Medicine Research},
  volume = {3},
  number = {3},
  pages = {68-73},
  doi = {10.11648/j.cmr.20140303.14},
  url = {https://doi.org/10.11648/j.cmr.20140303.14},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.cmr.20140303.14},
  abstract = {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.},
 year = {2014}
}

Copy | Download