Disparities in Hospitalized Chronic Obstructive Pulmonary Disease Exacerbations Among American Indians and Non-Hispanic Whites

Background The prevalence of chronic obstructive pulmonary disease (COPD) is high in American Indian (AI) populations, as are diabetes and obesity, which are common COPD comorbidities. However, COPD research among AI populations is limited. Study Design and Methods We conducted a retrospective study to investigate potential health disparities and risk factors among AI and non-Hispanic White (NHW) patients with COPD exacerbations hospitalized at the University of Oklahoma Medical Center between July 2001 and June 2020. Demographics, clinical variables and outcomes were collected. Results A total of 76 AI patients and 304 NHW patients were included. AI patients had more comorbidities than did NHW patients (4.3 vs.3.1, p<0.001). In multiple variable analyses, AI race was associated with higher odds of needing intensive care unit (ICU) care ( Odds Ratio [OR], 2.37, 95% Confidence interval [CI], 1.36-4.16, p=0.002) and invasive mechanical ventilator use (OR, 2.75, 95% CI, 1.42-5.29, p=0.002). AI race was also associated with longer ICU stay compared with NHW (OR, 1.43, 95% CI, 1.18-1.73, p<0.001). The average number of days on mechanical ventilator support would increase by 137.3% for an AI patient compared to a NHW patient (p<0.001). AI race was not associated with discharge to other health facilities (OR, 0.98, 95% CI, 0.52-1.83, p=0.944). Interpretation AI patients were more likely than NHW patients to need ICU care and ventilator support, have longer ICU stays, and days on mechanical ventilator support. More studies are needed to identify reasons for these disparities and effective interventions to reduce them.