Differences in level of care at the end of life according to race.
BACKGROUND
Tailoring care for patients and their families at the end of life is important.


OBJECTIVE
To examine factors associated with patients' choices for level of care at the end of life.


METHODS
Data on demographics and level of care (full code, do not resuscitate, or withdrawal of life support) were collected on 1072 patients who died between January 1998 and June 2006 on a cardiac care unit. Logistic regression was used to identify factors associated with level of care.


RESULTS
Median (interquartile range) age of blacks was 64 (50-74) years and of whites was 70 (62-78) years. At the time of death, the level of care differed significantly between blacks and whites: 41.8% (n = 112) of blacks versus 26.7% (n = 194) of whites chose full code (P <.001), 37.3% (n = 96) of blacks versus 43.9% (n = 317) of whites chose do not resuscitate (P = .03), and 20.9% (n = 54) of blacks versus 29.3% (n = 210) of whites chose withdrawal of life support (P = .005). After age, sex, diagnosis, and lengths of stay in intensive care unit and hospital were controlled for, blacks were more likely than whites to choose full code status at the time of death (odds ratio 1.91 [95% confidence interval, 2.63-1.39], P < .001).


CONCLUSIONS
Blacks are 1.9 times as likely as others to choose full code at time of death. Cultural differences should be acknowledged when providing end-of-life care.
Johnson
Rebecca W
RW
Heart Center at Duke University Health System in Durham, North Carolina, USA. johns151@mc.duke.edu
Newby
L Kristin
LK
Granger
Christopher B
CB
Cook
Wendy A
WA
Peterson
Eric D
ED
Echols
Melvin
M
Bride
Wanda
W
Granger
Bradi B
BB
D016223:Advance Directives / Q000706:statistics & numerical data*; D000368:Aged; D003710:Demography; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D044469:Racial Groups / Q000706:statistics & numerical data*; D012737:Sex Factors; D013727:Terminal Care / Q000379:methods* / Q000706:statistics & numerical data*