OBJECTIVE: Determine the relation of race and gender to outcome from bleeding peptic ulcer. DESIGN: Retrospective cohort study. SETTING: All acute care hospitals in the United States. PATIENTS: A 100% sample of hospitalized Medicare beneficiaries older than 64 years (n = 82,868) with a primary discharge diagnosis of peptic ulcer with hemorrhage. MEASUREMENTS AND MAIN RESULTS: Surgical treatment was performed in 6.9% of patients, 30-day mortality was 8.5%, and average length of stay was 9.4 days. Surgery was somewhat more common in men than women (7.3% vs 6.5%, p < .001), and in whites than African Americans (6.9% vs 6.3%, p < .001), but neither race nor gender was associated with surgery in multivariable analysis adjusting for potentially confounding factors. Mortality rates were similar in African Americans and whites (8.5%), and somewhat higher in men than women (10.7% vs 9.3%, p < .001). In multivariable analysis, there was no difference in mortality across gender and racial groups. Although unadjusted and adjusted lengths of stay were longer for African Americans and shorter for men, the differences were modest (i.e., 16% increase and 6% decrease in multivariable analysis, respectively, p < .0001). CONCLUSIONS: In this national sample, there is no significant gender or racial difference in therapy and outcome for patients with hemorrhagic peptic ulcer. The findings raise the possibility that studies that have shown race and gender differences in management of coronary artery disease and cancer may not be generalizable to other common diagnoses.
OBJECTIVE: Determine the relation of race and gender to outcome from bleeding peptic ulcer. DESIGN: Retrospective cohort study. SETTING: All acute care hospitals in the United States. PATIENTS: A 100% sample of hospitalized Medicare beneficiaries older than 64 years (n = 82,868) with a primary discharge diagnosis of peptic ulcer with hemorrhage. MEASUREMENTS AND MAIN RESULTS: Surgical treatment was performed in 6.9% of patients, 30-day mortality was 8.5%, and average length of stay was 9.4 days. Surgery was somewhat more common in men than women (7.3% vs 6.5%, p < .001), and in whites than African Americans (6.9% vs 6.3%, p < .001), but neither race nor gender was associated with surgery in multivariable analysis adjusting for potentially confounding factors. Mortality rates were similar in African Americans and whites (8.5%), and somewhat higher in men than women (10.7% vs 9.3%, p < .001). In multivariable analysis, there was no difference in mortality across gender and racial groups. Although unadjusted and adjusted lengths of stay were longer for African Americans and shorter for men, the differences were modest (i.e., 16% increase and 6% decrease in multivariable analysis, respectively, p < .0001). CONCLUSIONS: In this national sample, there is no significant gender or racial difference in therapy and outcome for patients with hemorrhagic peptic ulcer. The findings raise the possibility that studies that have shown race and gender differences in management of coronary artery disease and cancer may not be generalizable to other common diagnoses.
Authors: E S Fisher; F S Whaley; W M Krushat; D J Malenka; C Fleming; J A Baron; D C Hsia Journal: Am J Public Health Date: 1992-02 Impact factor: 9.308
Authors: G T O'Connor; J R Morton; M J Diehl; E M Olmstead; L H Coffin; D G Levy; C T Maloney; S K Plume; W Nugent; D J Malenka Journal: Circulation Date: 1993-11 Impact factor: 29.690