Secondary Logo

Institutional members access full text with Ovid®

Relationship Between African-American Race and Delirium in the ICU

Khan, Babar A. MD, MS; Perkins, Anthony MS; Hui, Siu L. PhD; Gao, Sujuan PhD; Campbell, Noll L. PharmD; Farber, Mark O. MD; Boustani, Malaz A. MD, MPH

doi: 10.1097/CCM.0000000000001813
Clinical Investigations
Buy
SDC

Objectives: Delirium is a highly prevalent syndrome of acute brain dysfunction among critically ill patients that has been linked to multiple risk factors, such as age, preexisting cognitive impairment, and use of sedatives; but to date, the relationship between race and delirium is unclear. We conducted this study to identify whether African-American race is a risk factor for developing ICU delirium.

Design: A prospective cohort study.

Setting: Medical and surgical ICUs of a university-affiliated, safety net hospital in Indianapolis, IN.

Patients: A total of 2,087 consecutive admissions with 1,008 African Americans admitted to the ICU services from May 2009 to August 2012.

Interventions: None.

Measurements and Main Results: Incident delirium was defined as first positive Confusion Assessment Method for the ICU result after an initial negative Confusion Assessment Method for the ICU; and prevalent delirium was defined as positive Confusion Assessment Method for the ICU on first Confusion Assessment Method for the ICU assessment. The overall incident delirium rate in African Americans was 8.7% compared with 10.4% in Caucasians (p = 0.26). The prevalent delirium rate was 14% in both African Americans and Caucasians (p = 0.95). Significant age and race interactions were detected for incident delirium (p = 0.02) but not for prevalent delirium (p = 0.3). The hazard ratio for incident delirium for African Americans in the 18–49 years age group compared with Caucasians of similar age was 0.4 (0.1–0.9). The hazard and odds ratios for incident and prevalent delirium in other groups were not different.

Conclusions: African-American race does not confer any additional risk for developing incident or prevalent delirium in the ICU. Instead, younger African Americans tend to have lower rates of incident delirium compared with Caucasians of similar age.

Supplemental Digital Content is available in the text.

1Department of Medicine, Indiana University School of Medicine, Indianapolis, IN.

2Indiana University Center for Aging Research, Indianapolis, IN.

3Regenstrief Institute, Indianapolis, IN.

4Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN.

5Eskenazi Health, Indianapolis, IN.

6Department of Pharmacy Practice, Purdue University College of Pharmacy, West Lafayette, IN.

This work was performed at Indiana University School of Medicine, Indianapolis, IN.

Mr. Campbell and Dr. Farber contributed to the conception and design and drafting the intellectual content of the article. Drs. Khan and Boustani contributed to the conception and design, analysis/interpretation of data, and drafting the intellectual content of the article. Mr. Perkins and Drs. Hui and Gao contributed to conception and design and analysis/interpretation of data.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

Supported, in part, by a grant from the National Institute on Aging (R01AG034205).

Dr. Khan’s work on the project was supported through a Career Development Award from the National Institute on Aging (NIA K23-AG043476). Dr. Khan received support for this article research from the National Institutes of Health (NIH). His institution received funding from the NIA (RO1 AG 034205) and from the NIA Career Development Award (NIA K23-AG 043476). Dr. Perkins received support for this article research from the NIH. His institution received funding from the NIA, the NIH, and Agency for Healthcare Research and Quality. Drs. Hui and Gao received support for this article research from the NIH. Their institutions received grant support from the NIH. Dr. Campbell received support for article research from the NIH. His institution received grant support from the NIA, Merck, and Astellas Pharma US. The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: bakhan@iu.edu

Copyright © by 2016 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.