J Natl Med Assoc
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This study compared mortality in African American and white patients admitted to veterans affairs (VA) hospitals for chronic obstructive pulmonary disease (COPD) exacerbation and determined the potential impact of differences in intensive care unit (ICU) admission and mechanical ventilation. Administrative data from 2003-2006 identified African American (n = 7159) and white (n = 43820) patients admitted to VA hospitals with COPD exacerbation. Hierarchical logistic regression was used to compare risk-adjusted 30-day or inhospital mortality in African American and white patients. ⋯ The risk-adjusted odds of death were lower for African Americans relative to white patients (OR, 0.71; p < .001) and in analyses that further adjusted for ICU admission and ventilation use (OR, 0.69; p <.001). Mortality was lower in African Americans than white veterans admitted for COPD exacerbation, even after adjusting for differences in ICU admission rates and ventilatory support. The lower risk-adjusted mortality in African Americans was not explained by more aggressive care.
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To examine statin prescribing for secondary cardiovascular disease prevention at primary care visits by older patients in 2005-2006. ⋯ Statins are prescribed at much fewer visits by higher-risk older patients, especially non-Hispanic black patients and Medicaid beneficiaries, than would be expected from their comorbidities.
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As a major provider of health care for racial and ethnic minority groups, the federal government has affirmed its commitment to the elimination of health disparities. Although numerous studies have examined health care disparities in various federal systems of care, few have examined these issues within TRICARE, the Department of Defense (DoDJ's program for providing health care coverage to members of the uniformed services and their dependents. ⋯ Although health disparities exist in health status and some measures of preventive care, black non-Hispanics and Hispanics often receive more equitable care under TRICARE than in the nation as a whole. These findings suggest the need to explore the characteristics of TRICARE that may be associated with more-favorable outcomes for racial and ethnic minority groups.
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Gallbladder perforation and gangrene ordinarily follow obstructive (calculous) cholecystitis with a higher frequency among immunocompromised patients or patients with intense inflammation of the gallbladder. The occurrence of typhoid intestinal perforation is common in the tropics, but GBP and gangrene have been reported sparingly. We report management challenges of 6 children with complications of acalculous cholecystitis from typhoid seen at our center. ⋯ Acalculous typhoid gallbladder perforation, though rare, presents with management challenges.