title: Decreasing use of percutaneous endoscopic gastrostomy tube feeding for veterans with dementia-racial differences remain.
abstract: OBJECTIVE
  Percutaneous endoscopic gastrostomy (PEG) tube placement is a widely used method for long-term enteral feeding of demented patients unable to take sufficient food by mouth. National time trends in PEG tube use over the last decade have not been previously reported. The objective of this study was to determine whether use of PEG tubes for patients with dementia has changed over time and by race.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  All Veterans Affairs hospitals.
  
  
  METHODS
  Using an administrative database of the Veterans Health Administration, all veterans with dementia and all veterans who received a PEG tube were identified between fiscal years 1990-2001.
  
  
  METHODS
  Proportion of PEG tube placement for dementia patients over time and by race.
  
  
  RESULTS
  Four hundred thirteen thousand six hundred twenty-seven dementia patients aged 60 and older were identified, of whom 6,464 (1.6%) received a PEG tube. Use of PEG tubes for dementia patients increased during the first half of the decade but subsequently decreased almost to baseline after peaking in 1996 (1990: 1.2%, 1996: 1.8%, 2001: 1.3%). Time trends in the use of PEG tube feeding for dementia patients varied by race. Specifically, the relative risk for PEG tube placement in African-American dementia patients increased from 1.65 (95% confidence interval (CI)=1.25-2.17, FY 1990) to 1.97 (95% CI=1.62-2.4, FY 2001).
  
  
  CONCLUSIONS
  Although the overall use of PEG tube feeding for dementia patients decreased over time, rates in use and changes in use over time varied significantly by race. Reasons for the differential use of this procedure should be explored.
authors.affiliation: Houston Center for Quality of Care and Utilization Studies, Michael E. DeBakey VA Medical Center, Houston, Texas 77030, USA. ubraun@bcm.tmc.edu <ubraun@bcm.tmc.edu>
authors.forename: Ursula K
authors.initials: UK
authors.lastname: Braun
authors.forename: Linda
authors.initials: L
authors.lastname: Rabeneck
authors.forename: Laurence B
authors.initials: LB
authors.lastname: McCullough
authors.forename: Diana L
authors.initials: DL
authors.lastname: Urbauer
authors.forename: Nelda P
authors.initials: NP
authors.lastname: Wray
authors.forename: David R
authors.initials: DR
authors.lastname: Lairson
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Beyth
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003704:Dementia / Q000150:complications* / Q000208:ethnology*; D004750:Enteral Nutrition / Q000706:statistics & numerical data* / Q000639:trends; D001068:Feeding and Eating Disorders / Q000628:therapy*; D005260:Female; D005774:Gastrostomy / Q000706:statistics & numerical data* / Q000639:trends; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D014481:United States; D014728:Veterans / Q000706:statistics & numerical data*; D044465:White People / Q000706:statistics & numerical data