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

Research output: Contribution to journalArticle

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

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 - Jan 1 2008

PMID: 18807433

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Racial and ethnic differences in the treatment of seriously ill patients : A comparison of African-American, Caucasian and Hispanic Veterans. / Braun, Ursula K.; McCullough, Laurence B.; Beyth, Rebecca J.; Wray, Nelda; Kunik, Mark E.; Morgan, Robert O.

In: Journal of the National Medical Association, Vol. 100, No. 9, 01.01.2008, p. 1041-1051.

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Harvard

Braun, UK, McCullough, LB, Beyth, RJ, Wray, N, Kunik, ME & Morgan, RO 2008, 'Racial and ethnic differences in the treatment of seriously ill patients: A comparison of African-American, Caucasian and Hispanic Veterans' Journal of the National Medical Association, vol. 100, no. 9, pp. 1041-1051. https://doi.org/10.1016/S0027-9684(15)31442-5

APA

Braun, U. K., McCullough, L. B., Beyth, R. J., Wray, N., Kunik, M. E., & Morgan, R. O. (2008). Racial and ethnic differences in the treatment of seriously ill patients: A comparison of African-American, Caucasian and Hispanic Veterans. Journal of the National Medical Association, 100(9), 1041-1051. https://doi.org/10.1016/S0027-9684(15)31442-5

Vancouver

Braun UK, McCullough LB, Beyth RJ, Wray N, Kunik ME, Morgan RO. Racial and ethnic differences in the treatment of seriously ill patients: A comparison of African-American, Caucasian and Hispanic Veterans. Journal of the National Medical Association. 2008 Jan 1;100(9):1041-1051. https://doi.org/10.1016/S0027-9684(15)31442-5

Author

Braun, Ursula K. ; McCullough, Laurence B. ; Beyth, Rebecca J. ; Wray, Nelda ; Kunik, Mark E. ; Morgan, Robert O. / Racial and ethnic differences in the treatment of seriously ill patients : A comparison of African-American, Caucasian and Hispanic Veterans. In: Journal of the National Medical Association. 2008 ; Vol. 100, No. 9. pp. 1041-1051.

BibTeX

@article{bb40da2d55a94ca0822e02c0ffad7312,
title = "Racial and ethnic differences in the treatment of seriously ill patients: A comparison of African-American, Caucasian and Hispanic Veterans",
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.",
keywords = "Intensive care, Race/ethnicity",
author = "Braun, {Ursula K.} and McCullough, {Laurence B.} and Beyth, {Rebecca J.} and Nelda Wray and Kunik, {Mark E.} and Morgan, {Robert O.}",
year = "2008",
month = "1",
day = "1",
doi = "10.1016/S0027-9684(15)31442-5",
language = "English (US)",
volume = "100",
pages = "1041--1051",
journal = "Journal of the National Medical Association",
issn = "0027-9684",
publisher = "National Medical Association",
number = "9",

}

RIS

TY - JOUR

T1 - Racial and ethnic differences in the treatment of seriously ill patients

T2 - Journal of the National Medical Association

AU - Braun, Ursula K.

AU - McCullough, Laurence B.

AU - Beyth, Rebecca J.

AU - Wray, Nelda

AU - Kunik, Mark E.

AU - Morgan, Robert O.

PY - 2008/1/1

Y1 - 2008/1/1

N2 - 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.

AB - 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.

KW - Intensive care

KW - Race/ethnicity

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UR - http://www.scopus.com/inward/citedby.url?scp=52449097499&partnerID=8YFLogxK

U2 - 10.1016/S0027-9684(15)31442-5

DO - 10.1016/S0027-9684(15)31442-5

M3 - Article

VL - 100

SP - 1041

EP - 1051

JO - Journal of the National Medical Association

JF - Journal of the National Medical Association

SN - 0027-9684

IS - 9

ER -

ID: 2516105