Sex, race, and the development of acute lung injury

Luciano B. Lemos-Filho, Mark E. Mikkelsen, Greg S. Martin, Ousama Dabbagh, Adebola Adesanya, Nina Gentile, Annette Esper, Ognjen Gajic, Michelle N. Gong

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background : Prior studies suggest that mortality differs by sex and race in patients who develop acute lung injury (ALI). Whether differences in presentation account for these disparities remains unclear. We sought to determine whether sexual and racial differences exist in the rate of ALI development and ALI-related mortality after accounting for differences in clinical presentations. Methods: This was a multicenter, observational cohort study of 5,201 patients at risk for ALI. Multivariable logistic regression with adjustment for center-level effects was used to adjust for potential covariates. Results: The incidence of ALI development was 5.9%; in-hospital mortality was 5.0% for the entire cohort, and 24.4% for those patients who developed ALI. Men were more likely to develop ALI compared to women (6.9% vs 4.7%, P < .001) and had a nonsignificant increase in mortality when ALI developed (27.6% vs 18.5%, P =.08). However, after adjustment for baseline imbalances between sexes these differences were no longer significant. Black patients, compared to white patients, presented more frequently with pneumonia, sepsis, or shock and had higher severity of illness. Black patients were less likely to develop ALI than whites (4.5% vs. 6.5%, P =.014), and this association remained statistically significant after adjusting for differences in presentation (OR, 0.66; 95 % CI, 0.45-0.96). Conclusions: Sex and race differences exist in the clinical presentation of patients at risk of developing ALI. After accounting for differences in presentation, there was no sex difference in ALI development and outcome. Black patients were less likely to develop ALI despite increased severity of illness on presentation.

Original languageEnglish (US)
Pages (from-to)901-909
Number of pages9
JournalChest
Volume143
Issue number4
DOIs
StatePublished - Apr 2013

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Sexual Development
Acute Lung Injury
Sex Characteristics
Mortality
Hospital Mortality
Observational Studies
Shock
Sepsis
Pneumonia
Cohort Studies
Logistic Models

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Lemos-Filho, L. B., Mikkelsen, M. E., Martin, G. S., Dabbagh, O., Adesanya, A., Gentile, N., ... Gong, M. N. (2013). Sex, race, and the development of acute lung injury. Chest, 143(4), 901-909. https://doi.org/10.1378/chest.12-1118

Sex, race, and the development of acute lung injury. / Lemos-Filho, Luciano B.; Mikkelsen, Mark E.; Martin, Greg S.; Dabbagh, Ousama; Adesanya, Adebola; Gentile, Nina; Esper, Annette; Gajic, Ognjen; Gong, Michelle N.

In: Chest, Vol. 143, No. 4, 04.2013, p. 901-909.

Research output: Contribution to journalArticle

Lemos-Filho, LB, Mikkelsen, ME, Martin, GS, Dabbagh, O, Adesanya, A, Gentile, N, Esper, A, Gajic, O & Gong, MN 2013, 'Sex, race, and the development of acute lung injury', Chest, vol. 143, no. 4, pp. 901-909. https://doi.org/10.1378/chest.12-1118
Lemos-Filho LB, Mikkelsen ME, Martin GS, Dabbagh O, Adesanya A, Gentile N et al. Sex, race, and the development of acute lung injury. Chest. 2013 Apr;143(4):901-909. https://doi.org/10.1378/chest.12-1118
Lemos-Filho, Luciano B. ; Mikkelsen, Mark E. ; Martin, Greg S. ; Dabbagh, Ousama ; Adesanya, Adebola ; Gentile, Nina ; Esper, Annette ; Gajic, Ognjen ; Gong, Michelle N. / Sex, race, and the development of acute lung injury. In: Chest. 2013 ; Vol. 143, No. 4. pp. 901-909.
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abstract = "Background : Prior studies suggest that mortality differs by sex and race in patients who develop acute lung injury (ALI). Whether differences in presentation account for these disparities remains unclear. We sought to determine whether sexual and racial differences exist in the rate of ALI development and ALI-related mortality after accounting for differences in clinical presentations. Methods: This was a multicenter, observational cohort study of 5,201 patients at risk for ALI. Multivariable logistic regression with adjustment for center-level effects was used to adjust for potential covariates. Results: The incidence of ALI development was 5.9{\%}; in-hospital mortality was 5.0{\%} for the entire cohort, and 24.4{\%} for those patients who developed ALI. Men were more likely to develop ALI compared to women (6.9{\%} vs 4.7{\%}, P < .001) and had a nonsignificant increase in mortality when ALI developed (27.6{\%} vs 18.5{\%}, P =.08). However, after adjustment for baseline imbalances between sexes these differences were no longer significant. Black patients, compared to white patients, presented more frequently with pneumonia, sepsis, or shock and had higher severity of illness. Black patients were less likely to develop ALI than whites (4.5{\%} vs. 6.5{\%}, P =.014), and this association remained statistically significant after adjusting for differences in presentation (OR, 0.66; 95 {\%} CI, 0.45-0.96). Conclusions: Sex and race differences exist in the clinical presentation of patients at risk of developing ALI. After accounting for differences in presentation, there was no sex difference in ALI development and outcome. Black patients were less likely to develop ALI despite increased severity of illness on presentation.",
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AU - Adesanya, Adebola

AU - Gentile, Nina

AU - Esper, Annette

AU - Gajic, Ognjen

AU - Gong, Michelle N.

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N2 - Background : Prior studies suggest that mortality differs by sex and race in patients who develop acute lung injury (ALI). Whether differences in presentation account for these disparities remains unclear. We sought to determine whether sexual and racial differences exist in the rate of ALI development and ALI-related mortality after accounting for differences in clinical presentations. Methods: This was a multicenter, observational cohort study of 5,201 patients at risk for ALI. Multivariable logistic regression with adjustment for center-level effects was used to adjust for potential covariates. Results: The incidence of ALI development was 5.9%; in-hospital mortality was 5.0% for the entire cohort, and 24.4% for those patients who developed ALI. Men were more likely to develop ALI compared to women (6.9% vs 4.7%, P < .001) and had a nonsignificant increase in mortality when ALI developed (27.6% vs 18.5%, P =.08). However, after adjustment for baseline imbalances between sexes these differences were no longer significant. Black patients, compared to white patients, presented more frequently with pneumonia, sepsis, or shock and had higher severity of illness. Black patients were less likely to develop ALI than whites (4.5% vs. 6.5%, P =.014), and this association remained statistically significant after adjusting for differences in presentation (OR, 0.66; 95 % CI, 0.45-0.96). Conclusions: Sex and race differences exist in the clinical presentation of patients at risk of developing ALI. After accounting for differences in presentation, there was no sex difference in ALI development and outcome. Black patients were less likely to develop ALI despite increased severity of illness on presentation.

AB - Background : Prior studies suggest that mortality differs by sex and race in patients who develop acute lung injury (ALI). Whether differences in presentation account for these disparities remains unclear. We sought to determine whether sexual and racial differences exist in the rate of ALI development and ALI-related mortality after accounting for differences in clinical presentations. Methods: This was a multicenter, observational cohort study of 5,201 patients at risk for ALI. Multivariable logistic regression with adjustment for center-level effects was used to adjust for potential covariates. Results: The incidence of ALI development was 5.9%; in-hospital mortality was 5.0% for the entire cohort, and 24.4% for those patients who developed ALI. Men were more likely to develop ALI compared to women (6.9% vs 4.7%, P < .001) and had a nonsignificant increase in mortality when ALI developed (27.6% vs 18.5%, P =.08). However, after adjustment for baseline imbalances between sexes these differences were no longer significant. Black patients, compared to white patients, presented more frequently with pneumonia, sepsis, or shock and had higher severity of illness. Black patients were less likely to develop ALI than whites (4.5% vs. 6.5%, P =.014), and this association remained statistically significant after adjusting for differences in presentation (OR, 0.66; 95 % CI, 0.45-0.96). Conclusions: Sex and race differences exist in the clinical presentation of patients at risk of developing ALI. After accounting for differences in presentation, there was no sex difference in ALI development and outcome. Black patients were less likely to develop ALI despite increased severity of illness on presentation.

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