Racial and ethnic differences in the treatment of seriously ill patients: A comparison of African-American, Caucasian and Hispanic Veterans

Ursula K. Braun, Laurence B. McCullough, Rebecca J. Beyth, Nelda Wray, Mark E. Kunik, Robert O. Morgan

Research output: Contribution to journalArticle

17 Scopus citations

Abstract

Background: No national data exist regarding racial/ethnic differences in the use of interventions for patients at the end of life. Objectives: To test whether among 3 cohorts of hospitalized seriously ill veterans with cancer, noncancer or dementia the use of common life-sustaining treatments differed significantly by race/ethnicity. Design: Retrospective cohort study during fiscal years 1991-2002. Patients: Hospitalized veterans >55 years, defined clinically as at high-risk for 6-month mortality, not by decedent data. Measurements: Utilization patterns by race/ethnicity for 5 life-sustaining therapies. Logistic regression models evaluated differences among Caucasians, African Americans and Hispanics, controlling for age, disease severity and clustering of patients within Veterans Affairs (VA) medical centers. Results: Among 166,059 veterans, both differences and commonalities across diagnostic cohorts were found. African Americans received more or the same amount of end-of-life treatments across disease cohorts, except for less resuscitation [OR=0.84 (0.77-0.92), p=0.002] and mechanical ventilation [OR=0.89 (0.85-0.94), p≤0.0001] in noncancer patients. Hispanics were 36% (cancer) to 55% (noncancer) to 88% (dementia) more likely to receive transfusions than Caucasians (p<0.0001). They received similar rates as Caucasians for all other interventions in all other groups, except for 161% higher likelihood for mechanical ventilation in patients with dementia. Increased end-of-life treatments for both minority groups were most pronounced in the dementia cohort. Differences demonstrated a strong interaction with the disease cohort. Conclusions: Differences in level of end-of-life treatments were disease specific and bidirectional for African Americans. In the absence of generally accepted, evidence-based standards for end-of-life care, these differences may or may not constitute disparities.

Original languageEnglish (US)
Pages (from-to)1041-1051
Number of pages11
JournalJournal of the National Medical Association
Volume100
Issue number9
DOIs
StatePublished - Sep 2008

Keywords

  • Intensive care
  • Race/ethnicity

ASJC Scopus subject areas

  • Medicine(all)

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