Ethnic differences in do-not-resuscitate orders after intracerebral hemorrhage.
OBJECTIVE
To explore ethnic differences in do-not-resuscitate orders after intracerebral hemorrhage.


METHODS
Population-based surveillance.


METHODS
Corpus Christi, Texas.


METHODS
All cases of intracerebral hemorrhage in the community of Corpus Christi, TX were ascertained as part of the Brain Attack Surveillance in Corpus Christi (BASIC) project.


METHODS
None.


RESULTS
Medical records were reviewed for do-not-resuscitate orders. Unadjusted and multivariable logistic regression were used to test for associations between ethnicity and do-not-resuscitate orders, both overall ("any do-not-resuscitate") and within 24 hrs of presentation ("early do-not-resuscitate"), adjusted for age, gender, Glasgow Coma Scale, intracerebral hemorrhage volume, intraventricular hemorrhage, infratentorial hemorrhage, modified Charlson Index, and admission from a nursing home. A total of 270 cases of intracerebral hemorrhage from 2000-2003 were analyzed. Mexican-Americans were younger and had a higher Glasgow Coma Scale than non-Hispanic whites. Mexican-Americans were half as likely as non-Hispanic whites to have early do-not-resuscitate orders in unadjusted analysis (odds ratio 0.45, 95% confidence interval 0.27, 0.75), although this association was not significant when adjusted for age (odds ratio 0.61, 95% confidence interval 0.35, 1.06) and in the fully adjusted model (odds ratio 0.75, 95% confidence interval 0.39, 1.46). Mexican-Americans were less likely than non-Hispanic whites to have do-not-resuscitate orders written at any time point (odds ratio 0.37, 95% confidence interval 0.23, 0.61). Adjustment for age alone attenuated this relationship although it retained significance (odds ratio 0.49, 95% confidence interval 0.29, 0.82). In the fully adjusted model, Mexican-Americans were less likely than non-Hispanic whites to use do-not-resuscitate orders at any time point, although the 95% confidence interval included one (odds ratio 0.52, 95% confidence interval 0.27, 1.00).


CONCLUSIONS
Mexican-Americans were less likely than non-Hispanic whites to have do-not-resuscitate orders after intracerebral hemorrhage although the association was attenuated after adjustment for age and other confounders. The persistent trend toward less frequent use of do-not-resuscitate orders in Mexican-Americans suggests that further study is warranted.
Zahuranec
Darin B
DB
Stroke Program, University of Michigan Medical School, Ann Arbor, MI, USA.
Brown
Devin L
DL
Lisabeth
Lynda D
LD
Gonzales
Nicole R
NR
Longwell
Paxton J
PJ
Smith
Melinda A
MA
Garcia
Nelda M
NM
Morgenstern
Lewis B
LB
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000208:ethnology*; D005260:Female; D006801:Humans; D008020:Life Support Care / Q000706:statistics & numerical data; D008297:Male; D017058:Mexican Americans / Q000706:statistics & numerical data*; D008875:Middle Aged; D011379:Prognosis; D012044:Regression Analysis; D016414:Resuscitation Orders; D013781:Texas; D044465:White People / Q000706:statistics & numerical data*
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