Sociodemographic factors and the assignment of do-not-resuscitate orders in patients with acute myocardial infarctions.
OBJECTIVE
This study examined the impact of sociodemographic and clinical factors, measured at the individual or ecological (zip code) level, on the assignment of do-not-resuscitate (DNR) orders.


METHODS
This was a retrospective study (analysis of secondary data).


METHODS
We used a probability sample of 974 patients admitted to 30 medium to large California hospitals with acute myocardial infarctions in 1990 to 1991; the sample was originally designed to validate risk adjustment with administrative data.


METHODS
Multivariate logistic regression was used to adjust DNR assignment for age, gender, race, probability of death, functional impairments, payment source, hospital teaching status, and ecological measures of educational attainment, home ownership, and income.


RESULTS
DNR assignment was inversely associated with black race and positively associated with age, probability of death, cognitive impairment, and poor nutritional status. When the probability of death was very low, DNR orders were assigned less frequently to men than to women (odds ratio [OR], 0.4; 95% confidence interval [CI], 0.2 to 0.7 at probability of death = 0.10). However, men were significantly more likely to receive a DNR order than women when the probability of death was very high (OR, 4.4; 95% CI, 1.2 to 16.3 at probability of death = 0.90).


CONCLUSIONS
Older, white, sicker, or functionally impaired patients receive DNR orders more often than younger, black, healthier, or functionally intact patients do. Adjusting for these factors, DNR assignment is associated with gender through an interaction involving the probability of death. Future studies should reexamine the impact of these factors on DNR assignment and explore the role of patient values and patient-physician communication barriers.
García
J A
JA
Department of Internal Medicine, University of California Davis School of Medicine, Sacramento 95817-1498, USA. jzgarcia@ucdavis.edu
Romano
P S
PS
Chan
B K
BK
Kass
P H
PH
Robbins
J A
JA
D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002140:California; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000628:therapy*; D009752:Nutritional Status; D018579:Patient Selection; D011379:Prognosis; D044469:Racial Groups; D016414:Resuscitation Orders; D012189:Retrospective Studies; D020379:Risk Adjustment; D012737:Sex Factors; D012959:Socioeconomic Factors