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This article reviews the current evidence base for racial and ethnic disparities related to acute respiratory failure. It discusses the prevailing and most studied mechanisms that underlay these disparities, analytical challenges that face the field, and then uses this discussion to frame future directions to outline next steps for developing disparities-mitigating solutions.
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Enfermedad Crítica , Etnicidad , Disparidades en Atención de Salud , Insuficiencia Respiratoria , Humanos , Enfermedad Crítica/terapia , Insuficiencia Respiratoria/terapia , Insuficiencia Respiratoria/etnología , Disparidades en Atención de Salud/etnología , Adulto , Grupos Raciales , Enfermedad Aguda , Estados UnidosRESUMEN
BACKGROUND: Adjustment for race is discouraged in lung-function testing, but the implications of adopting race-neutral equations have not been comprehensively quantified. METHODS: We obtained longitudinal data from 369,077 participants in the National Health and Nutrition Examination Survey, U.K. Biobank, the Multi-Ethnic Study of Atherosclerosis, and the Organ Procurement and Transplantation Network. Using these data, we compared the race-based 2012 Global Lung Function Initiative (GLI-2012) equations with race-neutral equations introduced in 2022 (GLI-Global). Evaluated outcomes included national projections of clinical, occupational, and financial reclassifications; individual lung-allocation scores for transplantation priority; and concordance statistics (C statistics) for clinical prediction tasks. RESULTS: Among the 249 million persons in the United States between 6 and 79 years of age who are able to produce high-quality spirometric results, the use of GLI-Global equations may reclassify ventilatory impairment for 12.5 million persons, medical impairment ratings for 8.16 million, occupational eligibility for 2.28 million, grading of chronic obstructive pulmonary disease for 2.05 million, and military disability compensation for 413,000. These potential changes differed according to race; for example, classifications of nonobstructive ventilatory impairment may change dramatically, increasing 141% (95% confidence interval [CI], 113 to 169) among Black persons and decreasing 69% (95% CI, 63 to 74) among White persons. Annual disability payments may increase by more than $1 billion among Black veterans and decrease by $0.5 billion among White veterans. GLI-2012 and GLI-Global equations had similar discriminative accuracy with regard to respiratory symptoms, health care utilization, new-onset disease, death from any cause, death related to respiratory disease, and death among persons on a transplant waiting list, with differences in C statistics ranging from -0.008 to 0.011. CONCLUSIONS: The use of race-based and race-neutral equations generated similarly accurate predictions of respiratory outcomes but assigned different disease classifications, occupational eligibility, and disability compensation for millions of persons, with effects diverging according to race. (Funded by the National Heart Lung and Blood Institute and the National Institute of Environmental Health Sciences.).
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Pruebas de Función Respiratoria , Insuficiencia Respiratoria , Adolescente , Adulto , Anciano , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Enfermedades Pulmonares/diagnóstico , Enfermedades Pulmonares/economía , Enfermedades Pulmonares/etnología , Enfermedades Pulmonares/terapia , Trasplante de Pulmón/estadística & datos numéricos , Encuestas Nutricionales/estadística & datos numéricos , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Enfermedad Pulmonar Obstructiva Crónica/economía , Enfermedad Pulmonar Obstructiva Crónica/etnología , Enfermedad Pulmonar Obstructiva Crónica/terapia , Grupos Raciales , Pruebas de Función Respiratoria/clasificación , Pruebas de Función Respiratoria/economía , Pruebas de Función Respiratoria/normas , Espirometría , Estados Unidos/epidemiología , Insuficiencia Respiratoria/diagnóstico , Insuficiencia Respiratoria/economía , Insuficiencia Respiratoria/etnología , Insuficiencia Respiratoria/terapia , Negro o Afroamericano/estadística & datos numéricos , Blanco/estadística & datos numéricos , Evaluación de la Discapacidad , Ayuda a Lisiados de Guerra/clasificación , Ayuda a Lisiados de Guerra/economía , Ayuda a Lisiados de Guerra/estadística & datos numéricos , Personas con Discapacidad/clasificación , Personas con Discapacidad/estadística & datos numéricos , Enfermedades Profesionales/diagnóstico , Enfermedades Profesionales/economía , Enfermedades Profesionales/etnología , Financiación Gubernamental/economía , Financiación Gubernamental/estadística & datos numéricosRESUMEN
Rationale: Racial disparities in pain management have been previously reported for children receiving emergency care.Objectives: To determine whether patient race or ethnicity is associated with the broader goal of pain management and sedation among pediatric patients mechanically ventilated for acute respiratory failure.Methods: Planned secondary analysis of RESTORE (Randomized Evaluation of Sedation Titration for Respiratory Failure). RESTORE, a cluster-randomized clinical trial conducted in 31 U.S. pediatric intensive care units, compared protocolized sedation management (intervention arm) with usual care (control arm). Participants included 2,271 children identified as non-Hispanic white (white, n = 1,233), non-Hispanic Black (Black, n = 502), or Hispanic of any race (Hispanic, n = 536).Results: Within each treatment arm, neither opioid nor benzodiazepine selection, nor cumulative dosing, differed significantly among race and ethnicity groups. Black patients experienced fewer days with an episode of pain (compared with white patients in the control arm and with Hispanic patients in the intervention arm) and experienced less iatrogenic withdrawal syndrome (compared with white patients in either arm or with Hispanic patients in the intervention arm). The percentage of days awake and calm while intubated was not significantly different in pairwise comparisons by race and ethnicity groups in either the control arm (median: white, 75%; Black, 71%; Hispanic, 75%) or the intervention arm (white, 86%; Black, 88%; Hispanic, 85%).Conclusions: Across multiple measures, our study found scattered differences in sedation management among critically ill Black, Hispanic, and white children that did not consistently favor any group. However, racial disparities related to implicit bias cannot be completely ruled out.Clinical trial registered with clinicaltrials.gov (NCT00814099).
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Etnicidad , Disparidades en Atención de Salud , Manejo del Dolor , Insuficiencia Respiratoria , Adolescente , Población Negra , Niño , Preescolar , Cuidados Críticos , Femenino , Disparidades en Atención de Salud/etnología , Hispánicos o Latinos , Humanos , Lactante , Recién Nacido , Unidades de Cuidado Intensivo Pediátrico , Masculino , Estudios Multicéntricos como Asunto , Dolor/tratamiento farmacológico , Ensayos Clínicos Controlados Aleatorios como Asunto , Respiración Artificial , Insuficiencia Respiratoria/etnología , Insuficiencia Respiratoria/terapia , Población BlancaAsunto(s)
COVID-19/terapia , Cuidados Críticos , Etnicidad/estadística & datos numéricos , Sujetos de Investigación/estadística & datos numéricos , Insuficiencia Respiratoria/terapia , Sepsis/terapia , COVID-19/epidemiología , COVID-19/etnología , Ensayos Clínicos como Asunto , Enfermedad Crítica/epidemiología , Enfermedad Crítica/terapia , Femenino , Humanos , Masculino , Insuficiencia Respiratoria/epidemiología , Insuficiencia Respiratoria/etnología , SARS-CoV-2 , Sepsis/epidemiología , Sepsis/etnología , Distribución por SexoRESUMEN
BACKGROUND Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which originated in Wuhan, China, in late 2019 and has led to an ongoing pandemic. COVID-19 typically affects the respiratory tract and mucous membranes, leading to pathological involvement of various organ systems. Although patients usually present with fever, cough, and fatigue, less common manifestations have been reported including symptoms arising from thrombosis and thromboembolism. A spectrum of dermatologic changes is becoming recognized in patients with COVID-19 who initially present with respiratory symptoms. The mechanism behind these manifestations remains unclear. This report presents the case of a 47-year-old Hispanic man who developed cutaneous vasculitic lesions and gangrene of the toes following admission to hospital with COVID-19 pneumonia. CASE REPORT COVID-19 has been associated with cardiovascular disease entities including stroke, acute coronary syndrome, venous thromboembolism, and peripheral vascular disease. We present a case in which a 47-year-old Hispanic man arrived at the Emergency Department with COVID-19 and was admitted for respiratory failure. Despite anticoagulation initiated on admission in the presence of an elevated D-dimer, the patient developed gangrene of all his toes, which required bilateral transmetatarsal amputation. CONCLUSIONS This case shows that dermatologic manifestations may develop in patients who initially present with COVID-19 pneumonia. These symptoms may be due to venous thrombosis following SARS-CoV-2 vasculitis, leading to challenging decisions regarding anticoagulation therapy. Randomized controlled trials are needed to evaluate the efficacy of anticoagulation, to choose appropriate anticoagulants and dosing, and to assess bleeding risk.
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Infecciones por Coronavirus/complicaciones , Gangrena/etiología , Gangrena/cirugía , Neumonía Viral/complicaciones , Síndrome Respiratorio Agudo Grave/complicaciones , Dedos del Pie/cirugía , Vasculitis/etiología , Amputación Quirúrgica/métodos , COVID-19 , Infecciones por Coronavirus/diagnóstico , Servicio de Urgencia en Hospital , Estudios de Seguimiento , Gangrena/fisiopatología , Hispánicos o Latinos , Humanos , Masculino , Huesos Metatarsianos/cirugía , Persona de Mediana Edad , Multimorbilidad , Pandemias , Admisión del Paciente , Neumonía Viral/diagnóstico , Insuficiencia Respiratoria/diagnóstico , Insuficiencia Respiratoria/etnología , Insuficiencia Respiratoria/etiología , Medición de Riesgo , Síndrome Respiratorio Agudo Grave/diagnóstico , Dedos del Pie/irrigación sanguínea , Dedos del Pie/fisiopatología , Resultado del Tratamiento , Vasculitis/fisiopatologíaRESUMEN
Brazil has 896,917 Indigenous individuals distributed among 505 Indigenous lands. There are 274 different Indigenous languages within 305 Indigenous ethnic groups. The Indigenous population is susceptible to pandemics, especially to the current pandemic of COVID-19, which has spread rapidly. In Brazil, after the first COVID-19-confirmed Indigenous case on 05th June 2020, more 420 suspected cases, 1727 confirmed cases being 934 active cases, 715 cases with clinical cure, and 70 cases of death were accounted through the first week of June. The number of cases is underestimated, according to the Special Secretariat for Indigenous Health (SESAI) database, since the deaths are due to respiratory failure, possibly caused by COVID-19, but not confirmed. The first COVID-19-caused death was a 15-year-old Indigenous Yanomami teenage from Roraima State without known previous diseases history and/or comorbidities. In the present study, the importance of social isolation, especially for Indigenous people who are more vulnerable to the COVID-19, was highlighted by the identification of the infection community. An Indigenous of the Kokama ethnicity was infected after coming in contact with a Medical Doctor who was infected with the disease. Later, it was noticed that both, Indigenous and doctor, were responsible for COVID-19's transmission to 43 other Indigenous individuals (30 in Alto Rio Solimões and 13 in Parintis), causing possibly other confirmed deaths. The impact of COVID-19 for Indigenous population might be an unprecedented tragedy, and the government in Brazil must take emergency measures as the social isolation.
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COVID-19/etnología , Etnicidad , Indígenas Sudamericanos , Pandemias , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , COVID-19/mortalidad , COVID-19/transmisión , COVID-19/virología , Cadena de Infección , Niño , Preescolar , Comorbilidad , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Insuficiencia Respiratoria/etnología , Insuficiencia Respiratoria/etiología , Insuficiencia Respiratoria/mortalidad , Insuficiencia Respiratoria/virología , SARS-CoV-2 , Adulto JovenRESUMEN
OBJECTIVES: To evaluate the survival and neurodevelopmental impairment (NDI) in extremely low birth weight (ELBW) infants at 18 to 26 months with early hypoxemic respiratory failure (HRF). We also assessed whether African American infants with early HRF had improved outcomes after exposure to inhaled nitric oxide (iNO). METHODS: ELBW infants ≤1000 g and gestational age ≤26 weeks with maximal oxygen ≥60% on either day 1 or day 3 were labeled as "early HRF" and born between 2007 and 2015 in the Neonatal Research Network were included. Using a propensity score regression model, we analyzed outcomes and effects of exposure to iNO overall and separately by race. RESULTS: Among 7639 ELBW infants born ≤26 weeks, 22.7% had early HRF. Early HRF was associated with a mortality of 51.3%. The incidence of moderate-severe NDI among survivors was 41.2% at 18 to 26 months. Mortality among infants treated with iNO was 59.4%. Female sex (adjusted odds ratio [aOR]: 2.4, 95% confidence interval [CI]: 1.8-3.3), birth weight ≥720 g (aOR: 2.3, 95% CI: 1.7-3.1) and complete course of antenatal steroids (aOR: 1.6, 95% CI: 1.1-2.2) were associated with intact survival. African American infants had a similar incidence of early HRF (21.7% vs 23.3%) but lower exposure to iNO (16.4% vs 21.6%). Among infants with HRF exposed to iNO, intact survival (no death or NDI) was not significantly different between African American and other races (aOR: 1.5, 95% CI: 0.6-3.6). CONCLUSIONS: Early HRF in infants ≤26 weeks' gestation is associated with high mortality and NDI at 18 to 26 months. Use of iNO did not decrease mortality or NDI. Outcomes following iNO exposure were not different in African American infants.
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Broncodilatadores/uso terapéutico , Hipoxia/complicaciones , Recien Nacido Extremadamente Prematuro , Trastornos del Neurodesarrollo/epidemiología , Óxido Nítrico Sintasa de Tipo II/uso terapéutico , Insuficiencia Respiratoria/mortalidad , Administración por Inhalación , Negro o Afroamericano , Puntaje de Apgar , Peso al Nacer , Broncodilatadores/administración & dosificación , Femenino , Rotura Prematura de Membranas Fetales , Mortalidad Hospitalaria , Humanos , Hipertensión Pulmonar/tratamiento farmacológico , Incidencia , Lactante , Recien Nacido con Peso al Nacer Extremadamente Bajo , Recién Nacido , Masculino , Trastornos del Neurodesarrollo/diagnóstico , Trastornos del Neurodesarrollo/tratamiento farmacológico , Trastornos del Neurodesarrollo/etnología , Óxido Nítrico Sintasa de Tipo II/administración & dosificación , Alta del Paciente , Embarazo , Puntaje de Propensión , Insuficiencia Respiratoria/tratamiento farmacológico , Insuficiencia Respiratoria/etnología , Insuficiencia Respiratoria/etiología , Factores de Riesgo , Factores Sexuales , Esteroides/uso terapéuticoAsunto(s)
Betacoronavirus , Infecciones por Coronavirus/etnología , Disparidades en Atención de Salud/etnología , Puntuaciones en la Disfunción de Órganos , Neumonía Viral/etnología , Grupos Raciales , Nivel de Atención , COVID-19 , Comorbilidad , Infecciones por Coronavirus/terapia , Recolección de Datos , Escala de Coma de Glasgow , Prioridades en Salud , Hispánicos o Latinos , Humanos , Pandemias , Neumonía Viral/terapia , Insuficiencia Respiratoria/etnología , Insuficiencia Respiratoria/terapia , Factores de Riesgo , SARS-CoV-2 , Índice de Severidad de la Enfermedad , Determinantes Sociales de la Salud , Estados Unidos/epidemiologíaRESUMEN
CONTEXT: Thyrotoxic periodic paralysis (TPP) is a relatively common complication seen in Asian hyperthyroid patients. However, it is a rare occurrence to find a TPP case comprised of acute hypercapnic respiratory failure in patients with painless thyroiditis. PATIENT: A 29-year-old Chinese man presented with flaccid paralysis of all four limbs and he was brought to emergency room. Severe hypokalemia was found on admission. Although treatment had been initiated with potassium chloride supplementation, he went on to develop acute hypercapnic respiratory failure likely due to muscle fatigue. The patient was intubated for mechanical ventilatory support. Once his serum potassium levels were normalized, he was able to be weaned off ventilator support. Thyroid function tests showed elevated free thyroxine concentration and low thyroid-stimulating hormone concentration. He underwent a thyroid uptake scan with 131I which revealed decreased uptake rate of thyroid area. Based on the patient's clinical presentation and associated findings, we diagnosed him with TPP due to painless thyroiditis. We have reviewed TPP cases caused by painless thyroiditis and TPP cases associated with acute hypercapnic respiratory failure. CONCLUSION: It is important to note that potentially fatal complications such as acute hypercapnic respiratory failure might occur in acute attacks of TPP even in cases of TPP due to painless thyroiditis.
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Hipercapnia/complicaciones , Parálisis Periódica Hipopotasémica/complicaciones , Insuficiencia Respiratoria/complicaciones , Tiroiditis/complicaciones , Adulto , Pueblo Asiatico , Humanos , Hipercapnia/diagnóstico , Hipercapnia/etnología , Hipopotasemia/etnología , Hipopotasemia/etiología , Parálisis Periódica Hipopotasémica/diagnóstico , Parálisis Periódica Hipopotasémica/etnología , Masculino , Paraplejía/etnología , Paraplejía/etiología , Insuficiencia Respiratoria/diagnóstico , Insuficiencia Respiratoria/etnología , Tiroiditis/diagnóstico , Tiroiditis/etnologíaRESUMEN
BACKGROUND: Reduction of 30-day readmissions in patients hospitalized for chronic obstructive pulmonary disease (COPD) is a national objective. However, there is a dearth of research on sex and racial/ethnic differences in the reason for 30-day readmission. METHODS: We conducted a retrospective cohort study using 2006-2012 data from the State Inpatient Database of eight geographically-diverse US states (Arkansas, California, Florida, Iowa, Nebraska, New York, Utah, and Washington). After identifying all hospitalizations for COPD made by patients aged ≥40 years, we investigated the primary diagnostic code for all-cause readmissions within 30 days after the original COPD hospitalization, among the overall group and by sex and race/ethnicity strata. RESULTS: Between 2006 and 2012, there was a total of 845,465 COPD hospitalizations at risk for 30-day readmissions in the eight states. COPD was the leading diagnostic for 30-day readmission after COPD hospitalization, both overall (28%) and across all sex and race/ethnicity strata. The proportion of respiratory diseases (COPD, pneumonia, respiratory failure, and asthma) as the readmission diagnosis was higher in non-Hispanic black (55%), compared to non-Hispanic white (52%) and Hispanics (51%) (p < 0.001). The proportion of asthma as the readmission diagnosis differed significantly by sex (6% in men and 9% in women; p < 0.001). Similarly, the proportion of asthma also differed significantly by race/ethnicity (5% in non-Hispanic white, 16% in non-Hispanic black, 15% in Hispanics, 13% in others; p < 0.001). CONCLUSIONS: In this analysis of all-payer population-based data, we found sex and racial/ethnic differences in the reason for 30-day readmission in patients hospitalized for COPD.
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Asma/etnología , Etnicidad/estadística & datos numéricos , Hospitalización , Grupos Minoritarios/estadística & datos numéricos , Readmisión del Paciente/estadística & datos numéricos , Enfermedad Pulmonar Obstructiva Crónica/etnología , Adulto , Negro o Afroamericano/estadística & datos numéricos , Anciano , Asma/epidemiología , Estudios de Cohortes , Bases de Datos Factuales , Femenino , Hispánicos o Latinos/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Neumonía/epidemiología , Neumonía/etnología , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Insuficiencia Respiratoria/epidemiología , Insuficiencia Respiratoria/etnología , Estudios Retrospectivos , Factores Sexuales , Clase Social , Estados Unidos/epidemiología , Población Blanca/estadística & datos numéricosRESUMEN
Importance: YARS2 mutations have been associated with a clinical triad of myopathy, lactic acidosis, and sideroblastic anemia in predominantly Middle Eastern populations. However, the identification of new patients expands the clinical and molecular spectrum of mitochondrial disorders. Objectives: To review the clinical, molecular, and genetic features of YARS2-related mitochondrial disease and to demonstrate a new Scottish founder variant. Design, Setting, and Participants: An observational case series study was conducted at a national diagnostic center for mitochondrial disease in Newcastle upon Tyne, England, and review of cases published in the literature. Six adults in a well-defined mitochondrial disease cohort and 11 additional cases described in the literature were identified with YARS2 variants between January 1, 2000, and January 31, 2015. Main Outcome and Measures: The spectrum of clinical features and disease progression in unreported and reported patients with pathogenic YARS2 variants. Results: Seventeen patients (median [interquartile range] age at onset, 1.5 [9.8] years) with YARS2-related mitochondrial myopathy were identified. Fifteen individuals (88%) exhibited an elevated blood lactate level accompanied by generalized myopathy; only 12 patients (71%) manifested with sideroblastic anemia. Hypertrophic cardiomyopathy (9 [53%]) and respiratory insufficiency (8 [47%]) were also prominent clinical features. Central nervous system involvement was rare. Muscle studies showed global cytochrome-c oxidase deficiency in all patients tested and severe, combined respiratory chain complex activity deficiencies. Microsatellite genotyping demonstrated a common founder effect shared between 3 Scottish patients with a p.Leu392Ser variant. Immunoblotting from fibroblasts and myoblasts of an affected Scottish patient showed normal YARS2 protein levels and mild respiratory chain complex defects. Yeast modeling of novel missense YARS2 variants closely correlated with the severity of clinical phenotypes. Conclusions and Relevance: The p.Leu392Ser variant is likely a newly identified founder YARS2 mutation. Testing for pathogenic YARS2 variants should be considered in patients presenting with mitochondrial myopathy, characterized by exercise intolerance and muscle weakness even in the absence of sideroblastic anemia irrespective of ethnicity. Regular surveillance and early treatment for cardiomyopathy and respiratory muscle weakness is advocated because early treatment may mitigate the significant morbidity and mortality associated with this genetic disorder.
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Acidosis Láctica/genética , Anemia Sideroblástica/genética , Cardiomiopatías/genética , Miopatías Mitocondriales/genética , Debilidad Muscular/genética , Insuficiencia Respiratoria/genética , Tirosina-ARNt Ligasa/genética , Acidosis Láctica/etnología , Acidosis Láctica/etiología , Adulto , Anciano , Anemia Sideroblástica/etnología , Anemia Sideroblástica/etiología , Cardiomiopatías/etnología , Cardiomiopatías/etiología , Inglaterra/etnología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Miopatías Mitocondriales/complicaciones , Miopatías Mitocondriales/etnología , Debilidad Muscular/etnología , Debilidad Muscular/etiología , Mutación , Pronóstico , Insuficiencia Respiratoria/etnología , Insuficiencia Respiratoria/etiología , Escocia/etnologíaRESUMEN
BACKGROUND: Motor neuron disease (MND) is a devastating degenerative disorder. Amyotrophic Lateral Sclerosis (ALS) is the most common and severe form of MND. Respiratory failure arising from ventilator musculature atrophy is the most common cause of death for ALS patients. Exploring the factors correlated with respiratory failure can contribute to disease management. PURPOSE: To characterize the clinical features of MND and determine the factors that may affect respiratory failure of MND patients. METHODS: The case records of all MND patients seen in Singapore General Hospital (SGH) between January 2004 and December 2014 were examined. Demographic, clinical information were collected by reviewing case records. Mortality data, if not available from records, were obtained via phone call interview of family members. Demographic data and clinical treatments were compared between Respiratory support group and Non-respiratory support group. RESULTS: There were 73 patients included in our study. 49 (67.1%) patients died during follow-up. The mean age of onset was 58±11.1years. With regard to treatment, 63% needed feeding support, and 42.5% required ventilation aid. The median overall survival was 36months from symptom onset. Chi-square tests showed there was significantly higher percentage of respiratory support needed in Chinese than in other races (P=0.016). Compared with non-feeding support patients, patients with feeding support were more likely to require assisted ventilation (P=0.001). CONCLUSIONS: We report for the first time that the need of feeding support is significantly associated with assisted ventilation. Chinese MND patients may be more inclined to require respiratory support.
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Enfermedad de la Neurona Motora/diagnóstico , Enfermedad de la Neurona Motora/etnología , Vigilancia de la Población , Grupos Raciales/etnología , Insuficiencia Respiratoria/diagnóstico , Insuficiencia Respiratoria/etnología , Adulto , Anciano , Esclerosis Amiotrófica Lateral/complicaciones , Esclerosis Amiotrófica Lateral/diagnóstico , Esclerosis Amiotrófica Lateral/etnología , Pueblo Asiatico/etnología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Enfermedad de la Neurona Motora/complicaciones , Insuficiencia Respiratoria/complicaciones , Estudios Retrospectivos , Factores de Riesgo , Singapur/etnologíaRESUMEN
RATIONALE: Racial disparities in health and healthcare in the United States are well documented and are increasingly recognized in acute critical illnesses such as sepsis and acute respiratory failure. OBJECTIVES: Using a large, representative, U.S. nationwide database, we examined the hypothesis that black and Hispanic patients with severe acute respiratory failure have higher mortality rates when compared with non-Hispanic whites. METHODS: This retrospective analysis used discharge data from the Agency for Healthcare Research and Quality, Nationwide Inpatient Sample, Healthcare Cost and Utilization Project, for the years 2008-2012. We identified hospitalizations with acute respiratory failure using a combination of International Classification of Diseases, Ninth Revision, Clinical Modification, codes. A logistic regression model was fitted to compare in-hospital mortality rates by race. MEASUREMENTS AND MAIN RESULTS: After adjusting for sex, age, race, disease severity, type of hospital, and median household income for patient ZIP code, blacks had a greater odds ratio of in-hospital death when compared with non-Hispanic whites (odds ratio [OR], 1.13; 95% confidence interval [CI], 1.11-1.14; P < 0.001), and Hispanics also had a greater odds ratio of in-hospital death when compared with non-Hispanic whites (OR, 1.17; 95% CI, 1.15-1.19; P < 0.001), and so did Asian and Pacific Islanders (OR, 1.15; 95% CI, 1.12-1.18; P < 0.001) and Native Americans (OR, 1.08; 95% CI, 1.00-1.15; P < 0.001) when compared with non-Hispanic whites (OR, 1.0). CONCLUSIONS: Blacks, Hispanics, and other racial minorities in the United States were observed to exhibit significantly higher in-hospital sepsis-related respiratory failure associated mortality when compared with non-Hispanic whites.
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Etnicidad/estadística & datos numéricos , Mortalidad Hospitalaria/etnología , Insuficiencia Respiratoria/etnología , Insuficiencia Respiratoria/mortalidad , Anciano , Anciano de 80 o más Años , Bases de Datos Factuales , Femenino , Disparidades en el Estado de Salud , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Estudios Retrospectivos , Factores de Riesgo , Clase Social , Estados Unidos/epidemiologíaRESUMEN
OBJECTIVES: The lung allocation score (LAS) system has been implemented to reduce waiting list time and mortality in the USA, but it remains uncertain how the LAS would reflect the impairment in health-related quality of life (HRQOL), which is another lung transplantation treatment goal to be improved in addition to survival. We thus investigated the relationships of the LAS with mortality and HRQOL in Japanese lung transplantation candidates. METHODS: One hundred and two candidates for lung transplantation at Kyoto University Hospital between 2009 and 2013 were consecutively recruited to participate in this study. Their physiological measurements of pulmonary function and 6-min walking distance, as well as patient-reported measurements of HRQOL, dyspnoea and psychological status, were assessed. RESULTS: Among these 102 patients, 22 died during a mean follow-up of 11.6 months. The LAS was significantly correlated to mortality (P = 0.0026), although other physiological measurements were not. However, regarding its relationship with HRQOL, correlation coefficients between the LAS, Medical Outcomes Study 36-item short form and St George's Respiratory Questionnaire (SGRQ) were relatively low, with the highest at 0.31. Multivariate analyses showed that the LAS was less significantly related to the SGRQ total score than dyspnoea, and psychological status. CONCLUSIONS: The LAS was significantly related to mortality in lung transplant candidates in Japan, while, despite its multidimensional scoring, its relationship with health-related quality of life was only weak. Their severity assessment system may be more focused on patients' health and symptoms.
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Indicadores de Salud , Trasplante de Pulmón , Pulmón/fisiopatología , Salud Mental , Calidad de Vida , Insuficiencia Respiratoria/diagnóstico , Listas de Espera , Adulto , Pueblo Asiatico , Prueba de Esfuerzo , Tolerancia al Ejercicio , Femenino , Estado de Salud , Hospitales Universitarios , Humanos , Japón , Estimación de Kaplan-Meier , Estudios Longitudinales , Pulmón/cirugía , Masculino , Persona de Mediana Edad , Análisis Multivariante , Valor Predictivo de las Pruebas , Pronóstico , Modelos de Riesgos Proporcionales , Insuficiencia Respiratoria/etnología , Insuficiencia Respiratoria/mortalidad , Insuficiencia Respiratoria/fisiopatología , Insuficiencia Respiratoria/psicología , Insuficiencia Respiratoria/cirugía , Factores de Riesgo , Índice de Severidad de la Enfermedad , Encuestas y Cuestionarios , Listas de Espera/mortalidadRESUMEN
AIM: To investigate, with extended follow-up, cause-specific mortality among low-income Black and White Americans with Type 2 diabetes who have similar socio-economic status. METHODS: Black and White Americans aged 40-79 years with Type 2 diabetes (n = 12 498) were recruited from community health centres as part of the Southern Community Cohort Study. Multivariable Cox analysis was used to estimate mortality hazard ratios and 95% CIs for subsequent cause-specific mortality, based on both underlying and contributing causes of death. RESULTS: During the follow-up (median 5.9 years), 13.3% of the study population died. The leading causes of death in each race were ischaemic heart disease, respiratory disorders, cancer, renal failure and heart failure; however, Blacks were at a lower risk of dying from ischaemic heart disease (hazard ratio 0.70, 95% CI 0.54-0.91) or respiratory disorders (hazard ratio 0.70, 0.53-0.92) than Whites but had higher or similar mortality attributable to renal failure (hazard ratio 1.57, 95% CI 1.02-2.40), heart failure (hazard ratio 1.47, 95% CI 0.98-2.19) and cancer (hazard ratio 0.87, 95% CI 0.62-1.22). Risk factors for each cause of death were generally similar in each race. CONCLUSIONS: These findings suggest that the leading causes of death and their risk factors are largely similar among Black and White Americans with diabetes. For the two leading causes of death in each race, however, ischaemic heart disease and respiratory disorders, the magnitude of risk is lower among Black Americans and contributes to their higher survival rates.
Asunto(s)
Negro o Afroamericano/estadística & datos numéricos , Diabetes Mellitus Tipo 2/mortalidad , Isquemia Miocárdica/mortalidad , Neoplasias/mortalidad , Insuficiencia Renal/mortalidad , Insuficiencia Respiratoria/mortalidad , Población Blanca/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Causas de Muerte , Estudios de Cohortes , Diabetes Mellitus Tipo 2/etnología , Femenino , Estudios de Seguimiento , Accesibilidad a los Servicios de Salud , Disparidades en el Estado de Salud , Humanos , Masculino , Persona de Mediana Edad , Isquemia Miocárdica/etnología , Neoplasias/etnología , Vigilancia de la Población , Insuficiencia Renal/etnología , Insuficiencia Respiratoria/etnología , Factores Socioeconómicos , Estados Unidos/epidemiologíaRESUMEN
A 42-year-old man was directly admitted to the ICU with respiratory failure and hypotension. Two weeks prior and just after returning from Bangladesh, he presented to a polyclinic with fever, right knee pain, and generalized aches, for which he received oral antibiotics. He was a farmer, had diabetes, never smoked, and consumed alcohol occasionally.
Asunto(s)
Artritis Infecciosa/etiología , Articulación de la Rodilla , Melioidosis/complicaciones , Insuficiencia Respiratoria/etiología , Choque Séptico/complicaciones , Adulto , Artritis Infecciosa/diagnóstico , Artritis Infecciosa/etnología , Bangladesh/etnología , Burkholderia pseudomallei/aislamiento & purificación , Diagnóstico Diferencial , Humanos , Kuwait/epidemiología , Masculino , Melioidosis/diagnóstico , Melioidosis/etnología , Radiografía Torácica , Insuficiencia Respiratoria/diagnóstico , Insuficiencia Respiratoria/etnología , Choque Séptico/diagnóstico , Choque Séptico/etnología , Líquido Sinovial/microbiología , Tomografía Computarizada por Rayos X , ViajeRESUMEN
The poor working conditions of Latina hotel cleaners render them particularly vulnerable to elevated occupational hazards that lead to adverse health outcomes. This article presents a comprehensive review of occupational risks (including physical, chemical, biological, and psychosocial risk factors) and health outcomes (including musculoskeletal disorders, respiratory diseases, dermatological diseases and allergies, and psychological disorders) for Latina hotel cleaners, within their unique sociocultural contexts. Preventive interventions for improving Latina hotel cleaners' work and health conditions are recommended.
Asunto(s)
Hispánicos o Latinos/estadística & datos numéricos , Tareas del Hogar/estadística & datos numéricos , Enfermedades Profesionales/etnología , Exposición Profesional/estadística & datos numéricos , Salud de la Mujer/etnología , Femenino , Humanos , Enfermedades Musculoesqueléticas/etnología , Insuficiencia Respiratoria/etnología , Factores de Riesgo , Estrés Psicológico/etnología , Estados Unidos , Lugar de Trabajo/estadística & datos numéricosRESUMEN
OBJECTIVES: Septic shock (SS) and respiratory failure (RF) are serious complications after neurosurgical procedures. Research is limited in studying racial/ethnic disparities in incidence and mortality of SS and RF. The study aimed to determine the racial variation in incidence and mortality from SS and RF among elective neurosurgical patients in California. METHODS: Data were analyzed from 206 902 admissions of elective neurosurgical patients in California from 2001 to 2009. Variables included race/ethnicity, age, gender, insurance, procedure site, and co-morbidities. We used descriptive, bivariate, and multivariate statistics in SAS v9·3. RESULTS: Septic shock incidence was 0·30/1000/year and case fatality (CF) was 47·7%. Respiratory failure incidence was 4·7/1000/year and CF was 26·2%. Blacks had higher SS and RF (0·6 and 7·9%, respectively) compared to Whites (0·2 and 4·3%, respectively) (Chi-square, P < 0·01). In the adjusted logistic regression model, Blacks had higher odds of SS (Adjusted Odds Ratio [AOR] â=â 1·56, 95% CI â=â 1·16-2·10) and RF (AOR â=â 1·22, 95% CI â=â 1·11-1·33) relative to Whites. Although, Blacks had higher mortality from SS (58·9%) and RF (30·1%) compared to Whites (45·2 and 26·4%, respectively; P < 0·05), the AORs were not statistically significant (P > 0·05). DISCUSSION: Blacks had a higher incidence of SS and RF. A higher percentage of black patients died from SS-related mortality, followed by Hispanics, than other groups. The attenuation of differences after statistical adjustment suggests the excess mortality may be due to age, site of the procedures, and having neoplastic disease. Our findings support the need for prospective studies to assess specific pre-operative interventions driven by age and co-morbidities that might reduce the risk of complications after neurosurgical procedures.
Asunto(s)
Procedimientos Quirúrgicos Electivos/efectos adversos , Procedimientos Neuroquirúrgicos/efectos adversos , Insuficiencia Respiratoria/etnología , Insuficiencia Respiratoria/mortalidad , Choque Séptico/etnología , Choque Séptico/mortalidad , Adolescente , Adulto , Factores de Edad , Anciano , California , Bases de Datos Factuales , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Adulto JovenRESUMEN
OBJECTIVE: Spirometric Z scores by lambda-mu-sigma (LMS) rigorously account for age-related changes in lung function. Recently, the Global Lung Function Initiative (GLI) expanded LMS spirometric Z scores to multiple ethnicities. Hence, in aging populations, the GLI provides an opportunity to rigorously evaluate ethnic differences in respiratory impairment, including airflow limitation and restrictive pattern. METHODS: Using data from the Third National Health and Nutrition Examination Survey, including participants aged 40-80, we evaluated ethnic differences in GLI-defined respiratory impairment, including prevalence and associations with mortality and respiratory symptoms. RESULTS: Among 3506 white Americans, 1860 African Americans and 1749 Mexican Americans, the prevalence of airflow limitation was 15.1% (13.9% to 16.4%), 12.4% (10.7% to 14.0%) and 8.2% (6.7% to 9.8%), and restrictive pattern was 5.6% (4.6% to 6.5%), 8.0% (6.9% to 9.0%) and 5.7% (4.5% to 6.9%), respectively. Airflow limitation was associated with mortality in white Americans, African Americans and Mexican Americans-adjusted HR (aHR) 1.66 (1.23 to 2.25), 1.60 (1.09 to 2.36) and 1.80 (1.17 to 2.76), respectively, but associated with respiratory symptoms only in white Americans-adjusted OR (aOR) 2.15 (1.70 to 2.73). Restrictive pattern was associated with mortality but only in white Americans and African Americans-aHR 2.56 (1.84 to 3.55) and 3.23 (2.06 to 5.05), and associated with respiratory symptoms but only in white Americans and Mexican Americans-aOR 2.16 (1.51 to 3.07) and 2.12 (1.45 to 3.08), respectively. CONCLUSIONS: In an aging population, we found ethnic differences in GLI-defined respiratory impairment. In particular, African Americans had high rates of respiratory impairment that were associated with mortality but not respiratory symptoms.
Asunto(s)
Enfermedades Pulmonares/etnología , Insuficiencia Respiratoria/etnología , Adulto , Negro o Afroamericano , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Americanos Mexicanos , Persona de Mediana Edad , Encuestas Nutricionales , Oportunidad Relativa , Enfermedad Pulmonar Obstructiva Crónica/etnología , Insuficiencia Respiratoria/mortalidad , Espirometría , Población BlancaRESUMEN
BACKGROUND: The Northern region of the Negev desert is an endemic area of organophosphate and carbamate intoxications in Bedouin children. Most victims are intoxicated by drinking the poisonous material kept by the parents in soft drink bottles. Signs and symptoms of intoxication are commonly known and generally include various effects on the central nervous system, usually a decreased level of consciousness in children, cholinergic muscarinic (sweating, rhinorrhea, miosis, vomiting) and nicotinic (weakness) effects. Specific therapy includes Atropine Sulphate and Oximes. PURPOSE AND RESULTS: To describe the course of disease of four (out of 47) children admitted to the Division of Pediatrics with organophosphate or carbamate poisoning during a two-year period. The four children 3-17 years of age ingested the poisonous material: organophosphate chlorpyrifos (2 children); carbamate methomyl (one child) and an unidentified compound in another child. Three of the four patients ingested the poison in a suicide attempt. All 4 children suffered from severe and uncommon complications, including severe respiratory failure from different etiologies. In addition, two of the four suffered from a neurological deficit causing prolonged disability. Three had renal failure necessitating hemofiltration in one case. One child had severe hemodynamic failure and arrhythmias necessitating, among other therapy, the insertion of a temporary pace maker. Two children had (laboratory) pancreatitis. One of the children with severe respiratory failure died after 38 days of extracorporeal membrane oxygenation. CONCLUSIONS: Intoxications by anticholinesterase compounds are not uncommon among Bedouin children in the Negev. This public health threat should be prevented and completely eradicated by the health authorities. Severe intoxication, especially in cases arising after suicide attempts, wherein the amount of the poisonous material is large, may be complicated by life threatening, multi-organ failure during and after the initial phase of poisoning and may progress into prolonged disability and death.