In-hospital mortality rates from acute XXXX by race in U.S. hospitals: findings from the National Hospital Discharge Survey.

@entity1 @entity453 @entity583
Mortality rates in the United States from @entity453 are higher among blacks than whites at younger ages, with a crossover to lower rates above the age of 70. The factors that determine this crossover of age-specific death rates have not been elucidated. Selection from the black population of younger individuals who are sicker by virtue of being more coronary prone might leave a relatively healthier group of older @entity1 . Support for this hypothesis would consist in part of evidence that @entity453 has an earlier onset in the black population. We examined data from the National Hospital Discharge Survey for the years 1973-1984 to determine if age-related differences in case-fatality rates existed between whites and nonwhites. In-hospital case fatality rates were 10% to 70% higher for each of the 10 year age groups for nonwhites up to age 70, at which time a crossover occurred. The median age at death from @entity583 was approximately 5 years younger in nonwhites compared with whites. National estimates of hospitalization rates for @entity583 from these data likewise suggest that nonwhites receive less health care for @entity453 than whites relative to recorded fatal events. The age-specific trends in case-fatality support the hypothesis that a cohort selection effect in part determines the black/white differentials in @entity453 . Relative susceptibility of the black and white population is thus not appropriately estimated by age-adjusted rates, but should be examined on an age-specific basis within the framework of selection effects on a cohort.
