John Danziger, MD Harvard Medical Faculty Physicians, Nephrology Beth Israel Deaconess Medical Center 

Critically Ill African American Patients Do Less Well at Predominately Minority Hospitals Interview with:

John Danziger, MD Harvard Medical Faculty Physicians, Nephrology Beth Israel Deaconess Medical Center 

Dr. Danziger

John Danziger, MD
Harvard Medical Faculty Physicians, Nephrology
Beth Israel Deaconess Medical Center What is the background for this study?

Response: Racial health disparities have long been described, extending even into the highest levels of medical care, namely the Intensive Care Unit (ICU).

Accordingly, we wanted to know whether improvements in ICU care seen over the last decade are equally observed in minority and non-minority serving hospitals. What are the main findings?

Response: We found significant differences in ICU outcomes over the last decade amongst patients in minority serving hospitals compared to non-minority hospitals. What should readers take away from your report?

  • Nearly a third of critically ill African American and half of critically ill Hispanic patients were treated at only 14 of more than 200 surveyed hospitals.
  • A steady decline (about 2 percent) each year in ICU deaths at non-minority hospitals, but no decline after the first few years at minority hospitals.
  • Longer lengths of ICU and hospital stay and critical illness hospitalizations at minority hospitals than non-minority hospitals.
  • African Americans treated at non-minority hospitals experienced a 3 percent decline in mortality each year, compared to no decline in mortality when treated at minority hospitals. What recommendations do you have for future research as a result of this work?

Response: Our analysis can not resolve whether the worse outcomes are due to differences in hospital practices or differences in patient populations.  Either way however, as resource allocation is further stretched by the burgeoning costs of medical care, focusing on areas of greatest need is critical.  Our study identifies minority serving hospitals as an area of great need. These hospitals, and the patients they serve, require more support to mitigate the disadvantages facing African Americans.  This might include resources to better identify and treat those disease that preferentially affect African Americans, such as heart failure and kidney disease, as well as interventions to improve primary care access and health literacy in African American serving areas.

As a  nephrologist, I am particularly interested in the effect of racial disparities on kidney disease.  While African Americans have the highest rates of kidney failure amongst ethnic groupings, they tend to receive lower quality dialysis care.  Whether differences in access to the full range of dialysis and dialysis related therapies contribute to this disparity needs to be addressed.

I have no conflicts of interests or disclosures to make.


American Thoracic Society’s American Journal of Respiratory and Critical Care Medicine
January 2020

Temporal trends in critical care outcomes in United States minority serving hospitals



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Last Updated on January 17, 2020 by Marie Benz MD FAAD