title: End-of-life hospitalization for African American and non-Latino white nursing home residents: variation by race and a facility's racial composition.
abstract: BACKGROUND
  Hospitalization of nursing home residents at the end of life is common, more so among African Americans. Whether a nursing home's racial mix is associated with hospitalization is unknown.
  
  
  OBJECTIVE
  This study examined the association between race, a nursing home's racial mix, and end-of-life hospitalization.
  
  
  METHODS
  This was a retrospective cohort study.
  
  
  METHODS
  Studied were nursing home residents in New York (n = 14,159) and Mississippi (n = 1481) who died in 1995-1996 and had a minimum data set (MDS) assessment within 120 days of death.
  
  
  METHODS
  The outcome measure was the odds of hospitalization in the last 90 days of life. A variable reflecting a nursing home's proportion of African American residents (in 1995-1996) represented a nursing home's racial mix.
  
  
  RESULTS
  Forty-six percent of African Americans and 32% of whites were hospitalized in the last 90 days of life. After controlling for demographics, diagnoses, function, patient preferences (do-not-resuscitate [DNR]), and facility resources, nursing home residents in facilities having higher proportions of African American residents had greater odds of hospitalization (adjusted odds ratio [AOR] 1.14; 95% confidence interval [CI] 1.10, 1.18 in New York and AOR 1.35; 95% CI 1.24, 1.46 in Mississippi). Age and frailty interacted with race; older African Americans had a 16% greater likelihood (95% CI 1.08, 1.24) of hospitalization, and African Americans with more functional limitations had a 37% (95% CI 1.24, 1.51) greater likelihood of hospitalization than did comparable whites.
  
  
  CONCLUSIONS
  It appears higher end-of-life hospitalization rates for African American residents are attributable to the facilities where most reside, and to differential hospitalization of older or more functional limited residents.
authors.affiliation: Department of Community Health, Center for Gerontology and Health Care Research, Brown University Medical School, Providence, Rhode Island 02912, USA. Vincent_Mor@brown.edu
authors.forename: Vincent
authors.initials: V
authors.lastname: Mor
authors.forename: George
authors.initials: G
authors.lastname: Papandonatos
authors.forename: Susan C
authors.initials: SC
authors.lastname: Miller
mesh_terms: D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D008922:Mississippi; D009518:New York; D009735:Nursing Homes; D010360:Patient Transfer / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D019452:Terminally Ill / Q000706:statistics & numerical data*; D014481:United States; D044465:White People