• Katrina T Cannon, Mary Vaughan Sarrazin, Gary E Rosenthal, Ann E Curtis, Karl W Thomas, and Lauris C Kaldjian.
• Center for Research in the Implementation of Innovative Strategies in Practice, Iowa City VA Medical Center, Iowa City, Iowa, USA. cannonk@genesishealth.com
• Med Care. 2009 Jan 1;47(1):129-33.

BackgroundBlack patients are more likely than white patients to prefer and receive more life-sustaining interventions in advanced stages of disease. However, little is known about potential racial differences in use of mechanical ventilation (MV), and the newer modality of noninvasive ventilation (NIV), in treatment of chronic obstructive pulmonary disease (COPD).ObjectiveTo determine if rates of MV and NIV use differ among black and white patients admitted to Veterans Administration (VA) hospitals for COPD exacerbation.Research DesignRetrospective cohort analysis of VA database FY2003 to FY2005 including 153 hospitals nationwide.SubjectsAll black (n = 479) and white (n = 31,537) patients admitted with COPD exacerbation.MeasuresVentilation use during hospitalization as identified by ICD-9-CM codes for MV and NIV. Hierarchical logistic regression compared rates of MV or NIV use among black and white patients, adjusting for patient characteristics and accounting for hospital-level variation.ResultsUnadjusted rates of MV were higher in black patients than in white patients (4.1% vs. 3.0%; P < 0.001), but similar for NIV (6.0% vs. 6.1%; P = 0.65). The adjusted odds of MV for black patients relative to white patients remained higher (OR = 1.27, 95% CI: 1.01-1.54; P < 0.01) while the adjusted odds of NIV remained similar (OR = 0.94, 95% CI: 0.82-1.08; P = 0.38).ConclusionsBlack patients with COPD exacerbation in VA hospitals are more likely than white patients to receive MV, and this difference is not explained by available clinical or demographic variables. By contrast, black and white patients are equally likely to receive NIV. These findings suggest that unmeasured factors, such as patient preferences or disease severity, may be affecting the use of MV in this setting and therefore warrant further investigation.

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