Racial and ethnic differences in the treatment of seriously ill patients: a comparison of African-American, Caucasian and Hispanic veterans.
BACKGROUND
No national data exist regarding racial/ethnic differences in the use of interventions for patients at the end of life.


OBJECTIVE
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.


METHODS
Retrospective cohort study during fiscal years 1991-2002.


METHODS
Hospitalized veterans >55 years, defined clinically as at high-risk for 6-month mortality, not by decedent data.


METHODS
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 < or = 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.
Braun
Ursula K
UK
Michael E. DeBakey VA Medical Center, Section of Health Services Research, Houston Center for Quality of Care & Utilization Studies, USA. ubraun@bcm.edu
McCullough
Laurence B
LB
Beyth
Rebecca J
RJ
Wray
Nelda P
NP
Kunik
Mark E
ME
Morgan
Robert O
RO
D001741:Black or African American; D015331:Cohort Studies; D016638:Critical Illness / Q000628:therapy*; D006630:Hispanic or Latino; D006801:Humans; D008020:Life Support Care / Q000706:statistics & numerical data*; D008875:Middle Aged; D012189:Retrospective Studies; D014481:United States; D014728:Veterans; D044465:White People